Revised July 2010
EVENT REQUEST
Phone (661) 722-6451 FAX (661) 722-6452
Overtime Approval r Paperwork attached r Approved by phone rApproved by e-mail
Date of request Department/Group holding event Event date Day of week
Time event takes place Where event is to be held Expected attendance
Purpose or name of event
a.m.
p.m.
to
a.m.
p.m.
For IMC Use only
rEquipment to be set-up night before
Notations
An Event Request form is required for Events and/or Training/Videoconference Room use only.
To simply reserve a piece of equipment, a Reservation form is required or call x6451.
Date Individual approving OT by phone/e-mail Budget Amount
Special Instructions
• Eventsmustbescheduledtwo(2)weeksinadvance.
• Requestormaybechargedforovertime.
Contact Kim Whitaker @ x6072 to see if overtime will be necessary. Overtime authorization must be submitted with the event request on an overtime
form complete with the appropriate signature and budget number (forms available on intranet - HR - forms). Events will not be scheduled until all the
necessary paperwork is received by the IMC.
• CallITSforInternetaccess.
Theinternetisnotaccessibleinallrooms.ContactITStoconrmavailabilityand/oraccessandtogetanInternetcable.
I hereby acknowledge that I will be held responsible for damage or unnecessary abuse of school equipment or media resulting from the use of said items. I agree to abide by and
enforce the rules and regulations of the Antelope Valley Community College District governing the use of equipment and media.
Print name of requester Signature Extension
Quantity Item
Projectors
35mm Slide
Overhead
LCD
Portable Projection Screens
Tripods
r5x7
r8x5
r10x10
Rear Projection 10x7.5
Quantity Item
Televisions
27” Screen
rwith VCR
rwith DVD
35” Screen
rwith VCR
rwith DVD
Misellaneous
Easels
rFlipchart easel
rDry erase easel (small)
rDisplay easel
Quantity Item
Players/Recorders
DVD
VCR
Portable Presentation
Smart Cart
LCD projector with
r Mac laptop
 r PC laptop
r VCR r DVD
r Speakers
rInternet (supply own cable)
Quantity Item
Audio/Sound Equipment
Audio cassette deck
CD Player
Microphones:
rStandard
rWireless
rLapel
PA Systems:
r8-channel w/speakers
rPortable PA
rMini Vox
Lecturn w/microphone &
CD/MP3 player
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Antelope
Valley
College
Services
Requested
r BE 118
r BE 132
r Room use only
r Room and equipment
r Videoconference
Training/Videoconference Room Request
Host_________________________________
Contact_______________________________
Phone/Email___________________________
Member of Cenic? r Yes r No
Record Videoconference? r Yes r No
(Copy of permission must be attached)
(Attach coordinate packet -
all printed information)
r Audio taping
r Video taping
r Set-up/Break-down of equipment
r
Set-up/Break-down of equipment & assistance during event
r Provide background music during an event
(Available only with specialized set-ups)
r
Classical r Jazz r Pop/R&B r Variety
rOther _____________________________________
(Available only with specialized set-ups)
click to sign
signature
click to edit
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