Center of Emphasis

Name  *

E-mail address  *

Department  *

Campus/Location  *

Phone #  *

Requested Pickup Date and Estimated Return Date must be entered as MM/DD/YYYY, i.e. May 6, 2006 would be entered as 05/06/2006. Failure to use this format will result in a form error.

Requested Pickup Date  *

Requested Pickup Location  Macon Union *

Estimated Return Date   *

Requested Return Location  Macon Union *

Sony Handycam Video Camera operating instructions (PDF size 5.45 MB), if you need the instructions for the Handycam you can view and save this PDF for future reference.

The video camera may be checked out by faculty who wish to create instructional materials. Please state the educational purpose for requesting the video camera.*

Please read and print this form before submission. Bring the form with you when you pick up the equipment, it will be used as a checklist for checkout and return of equipment. The COE cannot guarantee that the equipment will be available at the requested time until we have checked our checkout availability calendar and send you a confirmation e-mail. All equipment is currently housed on the Union Avenue Campus. Therefore, a 24-hour notice is required to ensure the equipment is available and can be transported to the pick-up location.

Pick-up      Return
______     ______   Video Camera/Case & shoulder strap (Handycam®)
______     ______   Instruction Book
______     ______   AC-L15A/L15B AC adaptor
______     ______   NP-FM50 rechargeable battery pack (qty 2)
______     ______   A/V Connecting Cable
______     ______   Lens Cap (attached to camera)
______     ______   USB Cable
______     ______   CD-ROM (SPVD-011 USB Driver)
______     ______   1 DVD-RW (30 minute video record time)
______     ______   Wireless Remote Commander
______     ______   Cleaning cloth

Equipment Serial Number ____________________

Please read and initial all statements below.

____ I understand that I may be personally liable for the loss of College equipment in my possession.

____ I accept the equipment loan term of no more than two weeks. It is my understanding that failure to return the equipment at the end of the term may result in a loss of equipment privileges.

____ I am also aware the Center of Emphasis staff may recall the equipment, given a 24-hour notice, at any time during the loan term. If I need additional time I must contact Cathy Farr before the estimated return date and request an extension.

Date Out __________ Signature ______________________________

Date Returned __________ Signature ______________________________

Difficulty filling out this form?
Stop by one of the Centers for assistance, or e-mail Gary Shockley for assistance.