Class Number or Event Name:

Date & Time of Class or Event:

Room Number:

What equipment would you like to request?

16mm Projection:

3/4" Video Playback:

Audio Record/ Playback:

CD/ DVD/ Laserdisc:

3/4" Video Playback:

3/4" Video Playback:

Remote Mouse:

Document Camera:

Easel Pad and Markers:

Hi-8 Playback:

Mac Operating System 9:

Mac Operating System 10:

Multi-standard VCR:

Laser Pointer:

Overhead Projector:

Easel Pad and Markers:

PC Operating System 98:

PC Operating System XP:

Satellite TV:

Slide Projector:

Slide to Video:

Teleconference:

VCR:

Video Record:

Web Access:

White Board:

Wired/ Wireless Microphones:

Other:

If other, please specify: