AV, Videoconferencing, Multimedia Services or Project Request Form
What type of service are you requesting? (select one)
Multimedia Service or Project
Videoconferencing Service
I will need an AV projectionist on-site to set up and operate equipment.
I will not need an AV projectionist - but need equipment delivered; set up; and picked up afterward.
I only need AV equipment delivered and set up - I will return all equipment.
I will pick up all needed AV equipment but will need someone to pick it up afterward.
None of the above - I will pick up and return all AV equipment. (Location info below not required)

Where?                         Select Location from list >

or specify (auditorium name, or building and room #) >
MonthDayYear

hh:mm AM/PM
MonthDayYear

hh:mm AM/PM
Date I will pick up eqpt.
Time
Date I will return eqpt.
Time
If you will need this same service on a regular basis, please complete a form for each day or list additional dates and times here:
Bulleted fields below are required:
  • Requestor's Name:
    		•
    E-mail Address:
  • Department:
    		•
  • Box #:
    		•
  • Phone #:
    		•
    Bill To Name:
  • FIS Department #:
    		•
    Name of person who will be at the location at the time service is to be provided. This may be the person giving a lecture, your representative or a designated coordinator:

    For Curriculum-related events, Please select the following:
    NOTE: It is no longer necessary to submit AV Requests for First and Second-Year curricular events, since they are now coordinated with the Course Scheduling system.
    School Year: 2007/2008 2008/2009 2009/2010 2010/2011
    Class Year: First Year Second Year Third Year Fourth Year
    Course:
    Section (if applicable):
    Name of Class, Lecture, or Videoconferencing Event requiring services (For Curriculum-related events, enter the Subject):

    Equipment requested (check all that apply):
    Projectors and Tape Recorders:

    Slide Projector
    Dual Slide Projector
    Overhead
    Document Presenter
    TV/VCR
    Standard VCR
    SONY Data (Auditorium)
    How Many VCRs?
    Portable Projectors:
    Data/LCD Projector for Computer
      How many?

    Portable Computer:
    Computers must be reserved at least 24 hours in advance. Availability is NOT guaranteed.
    Gateway
    Macintosh G3
    Tablet    		How Many Gateways?
    How Many Macs?
    How Many Tablets?

    Monitors and Screens:

    19" Monitor
    25" Monitor
    How many monitors?
    Projection Screen -indicate screen size below:
        5 ft. 6 ft. 8 ft    		Microphones:
    Number of Lavalier Mics:
    Number of Table Top Mics:
    Wireless Microphone System

    Other:
    Laser Pointer
    Wireless Navigator
    Wireless RemoteCD Player
    Audiocassette Player/Recorder
    Easel
    Flip Chart & markers ($10 additional charge)
    Microviewer
    Podium with Microphone
    Portable Sound System
    Stage Lighting Equipment
    Video Camera
    Tripod
    Polycom Teleconference Services
    Polycom Videoconference Services
    Turning Technologies Polling System
            (For Curriculum Lectures ONLY)
    Other Services (Specify in Comments)
    Comments or other information:


    Prices:
    Technician's time is billed for delivery/setup and/or projection work.


    Monday-Friday 7:30 AM - 5:00 PM: $35/hour. Minimum 1/2 hour charge for either delivery or pickup service.
    Pricing at other times, subject to technician availability:
    Monday-Friday before 7:30 AM or after 5:00 PM: $50/hour. Minimum 1/2 hour charge for either delivery or pickup service.
    Weekends: $65/hour, 2 hour minimum.
    While audio-visual equipment is in your possession, you are responsible for any damage or loss. Your department will be billed the cost of any repair or replacement needed, plus a $50 processing fee.
    If you have any questions about this form or any services, please call 362-2793 Mon-Fri between 7:30 AM and 5:00 PM.

    A confirmation of this request will be printed and mailed to you for your signature within one business day. You will be contacted by phone if any equipment or service requested will not be available. This request is not confirmed until a SIGNED copy is returned to MSCITS Audio-Visual Services, Box 8218. If you prefer, you may fax a signed copy to 314-747-2866.

    If you do not receive a confirmation within 2 business days or if you have any questions about this form or any services, please call 362-2793 Mon-Fri between 7:30 AM - 5:00 PM.

    Failure to cancel a request at least 1 hour before scheduled service will result in a minimum 1/2 hour set up charge.

    This request does NOT reserve the room. Please be sure to request room reservations if you have not already done so. You will receive a separate room confirmation.

    If you have multimedia presentations that you require MSCITS-AV to load prior to your event please email them to MSCITS-AV@msnotes.wustl.edu.
    In the subject line of your email please include the following:
  • Date of Event
  • Location of Event
  • Start time of Event
    Presentations should be received NO LATER than twenty four hours prior to your event.



    This site is maintained by Medical School Central IT Services, Washington University, St. Louis, Missouri.
    To comment or inquire about this form please email mscits-av@msnotes.wustl.edu