AV Equipment and Service Online Order Form Reservations ARE NOT FINAL until they are confirmed by The Department of Audiovisual Services.

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Department Information Name: eMail Address: Primary Phone: Alt. Phone: Fax: Department Name: Department Address:   Event Information Event Name: Location: [select room] Admin Lib. 100 Admin Lib. 107 Baruch Aud. Basic Sci. 100 Basic Sci. 202 Basic Sci. 302 Basic Sci. 402 Basic Sci. 435 Basic Sci. 502 2West Amphith. Storm Eye Aud. Clinical Sci. 419 Clinical Sci. 628H Quad. F 302A Quad. F 302B Quad. F 310 Quad. D 209 Rutl. Twr 1131 Rutl. Twr 1225 Col. Nursing 104 Col. Nursing 110 Col. Nursing 116 Col. Nursing 220 Col. Nursing 322 Col. Nursing 403 Col. Nursing 524 Harper St. Ct 403 Harper St. Ct 404 Harper St. Ct 405 Harper St. Ct 409 Harper St. Ct 410 Harper St. Ct 411 Harper St. Ct 412 Harper St. Ct 413 Harper St. Ct 414 Harper St. Ct 439 Harper St. Ct 440 Other Other Location: Start Date: End Date: Event Start Time: a.m. p.m. Event End Time: a.m. p.m.   Equipment Reservation Check If Needed Qty. Check If Needed Qty. T.V. Monitor X VCR X Audiotape Recorder X Easel X 35mm Slide Projector X Projector Stand X Overhead Projector X Pointer X Screen X Microphone X Public Address System X Podium w/Sound X Laptop Computer and Video Projector X Mixer X Audioconference Phone X Wireless Microphone X   Explain Services Needed - (THERE IS A $15.00 DELIVERY/SETUP FEE) Check this box to acknowledge you need delivery and setup! ($15.00 additional charge)   Bulb Purchase Check if Needed Qty FHS X EYB X ENX X