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Media Booking Request Form
Please only include one request per submission.
START
1
Requesters Name
*
This field is required.
First Name
Last Name
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2
E-mail
*
This field is required.
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3
Phone Number
*
This field is required.
Please enter numbers only
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4
Do You Need Media Equipment?
YES
NO
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5
Equipment Setup For Event or Equipment on Loan?
Setup
Loan
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6
Do You Work For Middlesex College?
*
This field is required.
YES
NO
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7
What Department?
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8
What Organization or Company Are You From?
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9
What Middlesex College Representative Are You Working With?
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10
Event Name
*
This field is required.
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11
Has the room or event been booked in EMS?
YES
NO
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12
EMS Reservation #
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13
EMS Booking #
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14
Event Date
-
Date
Month
Day
Year
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15
Event Time
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Hour
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Minutes
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Until
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Minutes
AM
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AM
AM
PM
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16
Building
*
This field is required.
Academy
Billy Johnson Hall
Bookstore
Center 1
Center 2
Center 3
Center 4
Chambers Hall
College Center
Crabiel Hall
East Hall
Edison Hall
Facilities Management (Warehouse)
Gateway
Instructional Resource Center
Johnson Learning Center
L'Hommedieu Hall
Library
Main Hall
New Brunswick Center
North Hall
Performing Arts Center
Perth Amboy Center
Physical Education Center
Raritan Hall
South Hall
West Hall
Other
Off Campus
Academy
Billy Johnson Hall
Bookstore
Center 1
Center 2
Center 3
Center 4
Chambers Hall
College Center
Crabiel Hall
East Hall
Edison Hall
Facilities Management (Warehouse)
Gateway
Instructional Resource Center
Johnson Learning Center
L'Hommedieu Hall
Library
Main Hall
New Brunswick Center
North Hall
Performing Arts Center
Perth Amboy Center
Physical Education Center
Raritan Hall
South Hall
West Hall
Other
Off Campus
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17
What Room?
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18
What Equipment is Needed
Blu-Ray Player (plays CD, DVD & Blu-Ray)
Computer - Laptop
Computer - Room System
Document Camera
Mic - Handheld Wired
Mic - Handheld Wireless
Mic - Stand
Monitor - Flat Screen
Podium - with Computer & Gooseneck Mic
Projector - Digital
Screen - Single
Screen - Dual
Screen - Portable
Sound - Computer Speakers
Sound – 1 Speaker
Sound – 2 Speaker
Sound System – In Room
Sound System – Boom Box
Other Not Listed - Please Specify In The Notes
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19
Equipment Needed - Loan
Digital Audio Recorder
Laptop
Portable Projector Screen
Projector
Sony Handy Cam
Tripod
Webcam
USB Mic
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20
Equipment Needed - Loan.
Digital Audio Recorder
Laptop
Portable Projector Screen
Projector
Sony Handy Cam
Tripod
Webcam
USB Mic
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21
Equipment Pickup Date
Pick up equipment in JLC 136
-
Date
Year
Month
Day
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10
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12
Hour
00
15
30
45
30
00
15
30
45
Minutes
AM
PM
AM
AM
PM
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22
Equipment Return Date
Return equipment in JLC 136
-
Date
Year
Month
Day
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2
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11
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Hour
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40
50
30
00
10
20
30
40
50
Minutes
AM
PM
AM
AM
PM
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23
Notes
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24
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25
Type a question
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26
Tags
Todo
In Progress
Done
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Should be Empty:
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