Media Services Audiovisual Request
Contact Person
*
First Name
Last Name
Organization/Department Name
*
Organization Address/Department Location
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone Number
*
Format: (000) 000-0000.
Email
*
example@example.com
Event Name
*
Event Location/Building and Room
*
Event Date
*
-
Month
-
Day
Year
Date
Is this request for multiple dates?
*
Yes
No
Please list the other dates
*
One date per line. Add location(s) if not the same as previously provided Event Location/Building and Room.
Setup Time of AV Equipment
*
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Hour
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40
50
Minutes
AM
PM
AM/PM Option
Event Start Time
*
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Hour
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Minutes
AM
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AM/PM Option
Event End Time
*
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Hour
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Minutes
AM
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AM/PM Option
Departure Time
*
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Hour
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10
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Minutes
AM
PM
AM/PM Option
What equipment is needed?
*
Computer - laptop or system PC
Microphone(s)
Mobile Flat Screen
Podium
Projector/Screen or Flat Screen turned on in room
Room Sound System
Mobile Speaker System
Other
Provide a detailed description of your event and AV needs
*
Will your event be livestreamed or will it be hybrid?
*
Yes
No
What are you planning to do?
*
Please specify
Will you need access to the College’s Guest Wi-Fi Network?
*
Yes
No
What do you need to use the College’s Guest Wi-Fi Network for?
*
Please specify
Additional Information/Comments
Consent Agreement
*
Audio-visual requests are not approved until in writing from the Middlesex College Media Services Team
Submit
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