This form is for SPECIAL EVENTS DEPARTMENT ONLY! Choose a different form if you do not work @ Special Events.

2. Enter your extension or telephone number.

* 3. Enter the event name or meeting.

4. Enter the USI account# and fiscal agent's name.

* 5. Please enter room number(s) for delivery and separate if multiple rooms.

6. Type event date with mm/dd/yyyy format & time needed. You may have a total of 5 dates on this form.

Date # 1
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Date # 2
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Date # 3
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Date # 4
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Date # 5
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7. Enter ENDING time for each of those events noted above when equipment may be picked up.

Date # 1
:
Date # 2
:
Date # 3
:
Date # 4
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Date # 5
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* 8. Select day(s) of the week when equipment is needed.

* 9. Select equipment from the list below. If you need more than one, please specify.

11. Additional equipment needs? Please specify here.

12. Please indicate below if advance technical support is needed. Please include fiscal agent's name in OTHER.

PRINT A COPY OF THIS FORM and review before finalizing your order.

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