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UC Media Equipment Request Form
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University Center Media Equipment Request Form
Description...................................
If you see this don't fill out this input box.
Contact Information
Contact Name:
*
Contact Email:
*
Contact Phone Number:
*
UTC Sponsoring Organization, Group, or Department:
*
Responsible University Account (If Applicable):
*
Event Information
Event Name:
*
Event Description:
*
Event Location:
*
Date(s) of Requested Reservation:
*
For Day Use Only- Event Start and End Times:
Equipment Information
Please indicate the equipment requested by checking the appropriate boxes below.
Wired Microphone
Microphone Stand
Travel Projector
Projector Screen
Harbinger Speaker System
Aux Cord
Mixer
Other (Please explain below)
If "Other" was selected, please explain.
Please indicate the quantity of the device(s) checked above.
Leave additional comments here.
Liability Authorization
By signing your electronic signature below, you acknowledge that you are responsible for the care and safe return of all borrowed equipment. You or a member of your organization/department must return all equipment to the UTC University Center Office (Room 226). By signing, you also acknowledge that the equipment will be safeguarded from theft, elements of weather, and any other circumstances that may damage equipment. If equipment is damaged during the time of use, you or your organization may be liable for monetary damages and/or replacement of the equipment. Fees and replacement costs will be as the discretion of the UTC University Center Staff.
*
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