Equipment request / Program reservation

                                Program / Equipment request Form                 

 Name:  User ID:
Email address:

Program Name:                                                          Series?

 

Program description:

Expected Program Length   Hr   Min

 

                Circulated Equipment (Two Items may be borrowed at one time)

Equipment Pick Up Date:


                                  

         

Program Tape #  Program DVD #

Other Equipment needed (name and inventory number): ________________________________________________________

Equipment Return Date:                                                                     


                     Additional equipment and assistance are available by request. 

                            Call 978-772-5858 or email: program@AyerPAC.org

                                  Program Submission

User provided media:           Media Label:  

 

Exact Length Hr   Min   Sec        Leader Length Sec

                

Initial Cablecast Request Date:


 

Signed: _______________________________________________________   Date: ________________

 

                      User provided media may be picked up a week after cable casting.  APAC is not responsible

                   for media not claimed after 30 days.  Please discuss arrangements with the access coordinator.

                                                   A copy of this form his form must accompany media

                                Place program media in box outside community room at the Police Station