Media Booking Request

Belle Glade Campus Media Technology & Instructional Services Online Request

This form has been designed for advanced booking requests only. Please give us at least 24 hours (not including weekends and holidays) to process your request. Channel assignment for CCTV requests will be emailed to your College email address.

By submitting this request, I certify use will be incompliance with existing Copyright Laws and accept liability for any infringement incurred by its use.

Email Address @palmbeachstate.edu			Contact Phone Number (optional)
Equipment Request
Portable data projector with computer		Slide projector
Other - Please identify other
Location of use
Date of use	Month: Day: Year:
Beginning	am pm (time)	Ending	am pm (time)
Reservation Request
These items will have to be signed for, picked up and returned to MTIS office. These items may be checked out for up to seven days.
Date of pick-up	Month: Day: Year:
Pick-up time:	am pm (time)
	DV camcorder		with Tripod
	Digital Camera
	Boom Box		Laptop

Videotape/DVD 1 - A/V number
	Title
Videotape/DVD 2 - A/V number
	Title
CCTV Request
Date for Playback	Month: Day: Year:
A/V number		Title

Exact Times to start am pm (time)
Exact Times to start am pm (time)
Exact Times to start am pm (time)
A/V number		Title

Exact Times to start am pm (time)
Exact Times to start am pm (time)
Exact Times to start am pm (time)
Comments: