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Request Form

Please Note: This service is for exclusive use by faculty and staff of NMSU at Alamogordo. Please submit at least 1 week in advance of requested date. Your request will not be final until you have received a verbal or email confirmation from Media Services. Call 439-3655 if you have difficulty with this form.

Name:
Department:
Phone Number:
Email Address:
Equipment Needed:	TV/VCR 16 mm motion picture projector 35 mm Slide Projector Overhead Transparency Projector Filmstrip Projector Projection Screen Dry Erase Board Karaoke Cassette Player Audio Recorder Device Camera VHS Video Cassette Player VHS Camcorder Other
Other Equipment:
Date Needed:
Time Needed:
AM or PM:	AM PM
Date Finished:
Time Finished:
AM or PM:	AM PM
Location (Building & Room):
Any Other Services Needed: