Media Services
Faculty and Staff Media Request Form

Extension: (required) Department:
Today's Date: Telephone: (required)

Term Agreement

  • I agree to be financially responsible for any loss or damage occurring to the equipment while it is in my care.
  • I agree to keep said property in good and proper condition as determined by the District.
  • I agree to be the only person to use the equipment.
  • I will return it to the WHCL Media Specialist on the date stated below.

Agree to Terms (required)

Name of Event/Class: (required)

Starting Date of Event/Class: (required)

Ending Date of Event/Class: (required)  

Start Time of Event/Class: (required)      

End Time of Event/Class: (required)        

Recurrence/ Duration of Event/Class:      

Select Campus: (required) NAS Lemoore Lemoore

Pickup or delivery date and time, if different from time of actual event: (required)
Main Room or Area: (required)
Please fill out requests for Breakout Rooms on separate pages if media requests differ by room!

Equipment Needed

DVD Player        Laptop with CD drive        Laptop with DVD drive
Portable Sound System
(comes with 2 speakers, 2 mics, cd player and built-in mic stand)

WHCL Conference Center: Microphones # of
Hand Held       Head Set       Laptop Set       Internet Connection

AV Cart with Power Source:
Heavy-duty Extension Cord: Length:

Technical Assistance requested: Yes | No
set-up only      entire event

Please describe dress code:

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