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. *

Submit   Clear