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PLEASE DOUBLE-CHECK THIS FORM FOR ACCURACY!

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Event Details:
All classrooms must be vacated by 12:50 PM if reserved for the 12-1 hour. Be sure to tell your guest speakers in advance, and leave the classroom clean for your westernU classmates when you leave.

Food and Drink:
Location Details:
Please Note: Tech Support will contact you to schedule a training for any events occurring outside of normal business hours (M-F 8:00 a.m. - 5:00 p.m.)
Health and Safety:
Guest Information:


Please indicate the number needed next to each item. Leave blank if none required. The number in parentheses indicates how many are available.

Item Name Quantity Requested
Tables (20):
Chairs (140):
Extra Trash Cans:
Ice and Ice Buckets (5):
Extension Cords (25')(3):
PA System/Portable Speaker (Includes Wired Microphone):
Planning to play music:
Extra Wireless Microphone (2):
Microphone Stand (2):
Portable LCD Projector(1):
Portable Projection Screen (1):
Video Camera(No Operator) (1):
Portable Wood Podium (2):
American flag with stand (1):
California flag with stand (1):
WesternU flag with stand (1):

Item Name
10 Gallon Drink Cooler (1):
5 Gallon Drink Cooler (1):
Blood Glucose Monitor (5):
Blood Pressure Cuffs (11):
Cash Box - cash not included (1):
Coffee Marker-Percolator (coffee not included) (2):
Collapsible Easels (8):
Futbol Goal (2):
Ice Cream Scoops (3):
Knives (2):
Large Plastic Serving Spoons (12):
Medium Bowl (5):
Plastic Ladles (2):
Portable Speaker & Microphone (1):
Pop-up Tent, 10x10 (3) these are heavy!
Pop-up Tent, 12x12 (2) these are heavy!
Punch Bowl (1):
Speaker & Microphone, large (1) on-campus use only
Volleyball Net (1):
Whiteboard (1):
You will be financially responsible for any lost or damaged items.
You may request the following additional services; depends on the availability of our Classroom and Multimedia Services (CMS) staff:
For Off-Campus Events Only:

Indicate the date and time you would like to pick-up requested supplies. Multimedia equipment (e.g. PA system) must be checked-out by an employee (club advisor, etc.) Supplies will be available M-F from 8:00 a.m. to 5:00 p.m. only.

Please use the space below for additional comments and special requests:
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