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Audio/Visual Request for Special Events

Use this form to assist in the planning, scheduling and delivery of audio-visual (AV) equipment for university-sponsored events scheduled through the UIW Media Services Center and the Student Life Office.  This form must be completed and submitted within three (3) weeks of the event date. Unfortunately, we are unable to accommodate equipment changes made within 72 hours of delivery.  This form is for reservations only. The Media Center does not guarantee delivery until after the confirmation of reservations. Reservations are confirmed after checking availability.

Organization/Event Information
   
Organization Name:
Contact Person:
UIW Extension:
UIW Email:    
Budget Code*:
(*Optional - To cover expenses for Media Center personnel and/or damage to equipment)
   
Date of Event:
Time of Event:
Return Date:
Return Time:
Event Location:  # of expected attendees:
Delivery Date/Time:
   
Brief description of event:  
 
If event is to be videotaped or photographed by the Media Center, Please contact Adela Gott at ext. 3946

Equipment/Screen Requested
LCD Projector Qty:
Laptop Qty:
Document Camera Qty:
DVD VCR Combo Qty:
Small Speaker System Qty:
Polyvision Panel Qty:
Overhead Projector Qty:
Boom Box Radio Qty:
Wireless Pointer Qty:
Cordless Microphone Qty:
Corded Microphone Qty:
Lapel Microphone Qty:
Microphone Stands Qty:
Medium PA System (crowd of a 100 and under) Qty:
Large PA System (crowd of a 100 plus) Qty:
Other: Qty:
Other: Qty:
Other: Qty:

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