Technology & Media Production Department
26 Gibbs Street, Box 154
Rochester, NY 14604
Phone: (585) 274-1130 / Fax: (585) 274-1001
Email: a-v@esm.rochester.edu
Presentation / Lecture / Meeting
AV Equipment Request Form
Select Option
Self-Serve
Delivery & Pick-up by T&MP Staff
Please select the equipment necessary for your event.
Multiple Choices Allowed
Wireless Internet
Laptop - PC
Laptop - Mac
Projection Screen
Projector - Data
Projector - Overhead (transparencies)
Projector - Slide (35mm)
Document Camera (ex. music scores)
Audio Speakers
CD Boombox
CD Player
Laser Disc Player
DVD Player - Region 1 (North America)
DVD Player - Regions 2, 3, 4, 5, 6
VHS Player - (NTSC tapes only) (NO PAL)
Media Cart (TV/DVD/VHS)
Are you giving the presentation?
Yes
No
Audio Recorder (Compact Flash) with microphone & stand
Audio Recorder (CD) with microphone & stand
Audio Recorder (Mini-Disc) with microphone & stand
Video Camcorder (Hard Drive) with tripod
Video Camcorder (Mini-DVD) with tripod
Video Camcorder (Mini-DV) with tripod
Digital Camera (Memory Card) with tripod
Conference Call Unit
**Speaking Microphone required?
No
Yes, hand-held microphone
Yes, microphone with stand
If no, please list name, phone number,
and email address for the presenter(s)
in the additional information box.
** Note: T&MP Dept. will determine:
1. if location has equipment capabilities
2. if event requires sound reinforcement
3. if staff available to provide the service
Audio or Video Conference Call required? If yes, please give further details
No
Yes
Please answer the following questions to help identify equipment necessary for your event.
Laptop computer required?
Yes, a PC
Yes, a Mac
No, will provide own PC
No, will provide own Mac
Do you need a Mac adapter?
Yes If Yes, which Mac?
No
Presentation includes?
(multiple choices allowed)
Display Overhead Transparencies
Display paper documents (ex. music score)
Display 35mm Slides
Play VHS tape (NTSC) (no PAL)
Play DVD - Region 1 (North America)
Play DVD - Regions 2, 3, 4, 5, 6
Play Laser Disc
Play CD
Audio clips - iPod, MP3 player, laptop
Video & Audio clips - Website (ex: Utube)
PowerPoint Presentation?
No
Yes
Storage device for Presentation?
Personal Laptop
External Hard Drive
Thumb Drive
DVD
CD
University Network Drive
Wireless Internet required?
No
Yes
UR Wireless is the wireless network used throughout the Eastman School of Music and the University of Rochester.
Eastman provides UR Wireless in select areas of the Eastman campus for use by Eastman/University of Rochester
students, faculty, staff and guests.
See website for additional information. http://www.esm.rochester.edu/esmtmp/ecs/wifi.php
Do you require training and/or support
from the AV Technician? If so please give
further details.
Please continue to Page 2
Event Information
Start Time
Event Date
End Time
Event Location
Event Name
Additional time prior to the start of your event reserved for set-up?
No
Yes
Example:
(12:30 pm - 1:00 pm)
Set-Up Time
Additional time after your event ends reserved for tear down?
No
Yes
Tear Down Time
Example:
(3:00 pm - 3:30 pm)
Customer Information
First Name
Email Address
Last Name
Phone Number
University Affiliation
Administrator
Faculty
Staff
Student
None
U of R Campus
Eastman
Medical Center
Memorial Art Gallery
River Campus
Other
Additional
Information
T&MP Department lends equipment on a first-come, first-serve basis. It is best to reserve equipment at least one month in advance.
There are no guarantees for equipment requested less than a week in advance.
Please complete this form and print/save as a pdf document.
Email a-v@esm.rochester.edu and include the pdf document as an attachment.