Name:      

Email:      

Telephone #:  

Date equipment needed:       Preferred pick-up time:

Location equipment will be used:

Date equipment will be returned:       Equipment return time:
(Note: Equipment must be returned immediately after class period.)

Check all that apply:

Audio Cassette Recorder/Player	DVD Player	Slide Projector
Compact Disc Playback	Laptop (PC)	VCR
Computer Projector	Microphones	Video Tripod
Digital Video Camera	Overhead (Transparency) Projector	Video Camera
Digital Picture Camera	Portable Sound System

Special Instructions: Is there anything else that we need to know?