Media Technical Services

Phone: (520) 626-0151 | Fax (520) 626-2145	Semiannual Audiovisual Equipment Order Form

Dept/Event:	Account #
Requestor:	User:
Phone:	Fax:	Email:

Please check the audiovisual support that will be needed:	Additional Comments

Projector (LCD) or TV monitor
Laptop PC Internet Audio
VHS / DVD Player with monitor
Digital Audio Recorder 2nd Microphone
Telephone Conference System
Other: (Please Specify)

Month	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	17	18	19	20	21	22	23	24	25	26	27	28	29	30	31
Jul
Aug
Sep
Oct
Nov
Dec

Usual Deliveries
Room #	Start Time	End Time
Exceptions
Date	Room #	Start Time	End Time
Date
Date
Date
Date

Click here to receive a confirmation copy after your orders have been processed

After completing this form Email to mtsdesk@medadmin.arizona.edu or FAX to 626-2145 or return by campus mail to:

Biomedical Communications * Media Technical Services

PO Box 245032 * Room 3404C * Arizona Health Sciences Center

Media Technical Services Office Use Only Below

Order Received By/Date:	Reservations Made By:

Reservations Checked By:	Orders Filed By/Date: