Equipment request form

 

 

 

STURBRIDGE COMMUNITY PUBLIC ACCESS TELEVISION

Town Hall  308 Main Street, Sturbridge, MA  01566

Tel.  508-347-7267  Fax  508-347-7267

bbutcher@town.sturbridge.ma.us

 

*REQUEST TO BORROW AUDIO-VISUAL EQUIPMENT

 

NAME_____________________________________________DATE__________

I.D. REQUIRED, IF BORROWER IS UNDER 18 YEARS OF AGE, A PARENT MUST SIGN

ITEMS BORROWED

Camcorder________________________________Serial #___________

 

Batteries___________________________________________________

 

Tripod_____________________________________________________

 

Microphone_________________________Cables__________________

 

Video tape/ Disc/ Data Card____________________________________

 

OTHER:

 

 

 

 

*EXPECTED DATE OF RETURN

 

BORROWER’S SIGNATURE__________________________________________

 

RETURNED SIGNATURE___________________________DATE________________