Exit this survey 2019 AV Request Form Question Title * 1. Sponsor Question Title * 2. Program Title Question Title * 3. Program Date Standard AV provided to you at no charge:(1) Standing Microphone(1) Small Speaker(1) 6' Tripod Screen(1) LCD Projector Question Title * 4. Please list additional AV needs below Yes, I would like to rent additional equipment (and understand there is a fee) and have checked the items I am requesting below: Question Title * 5. Addition AV Items Laptop Computer - $185.00 4 Channel Mixer (required if using 2-4 microphones) - $50.00 Tabletop Microphone - $40.00 Wireless Lapel Microphone - $125.00 Podium Microphone - $50.00 Wireless Handheld Microphone - $125.00 Flipchart w/ Pad & Markers - $35.00 PowerPoint Remote - $40.00 Other (please specify) ** Please Note: All rented A/V items will be assessed an A/V labor fee** Question Title * 6. To save on rental costs, you are allowed to supply your own audio/visual equipment. If you plan to bring your own laptop, flip chart, etc. please list the equipment below: Question Title * 7. Submitted by Name Affiliation Email Address Done
