"Over-the-Counter"
AV Equipment Borrowing Reservation Form

Please note: There is a limited supply of portable AV equipment
(for internal use only)

Applicant Identification Section
    *Denotes required entry
Name: *
Name of meeting (ie: Lab meeting, Neurology Rounds)
*
Pavilion:
Other
:

* Info?

Institution: * 
      Other:
Department: *  Room Number: *
Telephone#: * 
Email Address: *
MUHC Cost Centre Number:
Notice: Required by MUHC Staff

See Rental Price List
Applies to MUHC for Rental Fees.
   For others please call (514)398-5767
Please Note:
AV Service counter
is open from
9am to 4:30pm.
Equipment Borrowing Date(s) and Times
Pickup Date: *è
Please select date by using the above calendar
Pickup Time: *
Return Date: è
Please select date by using the above calendar
(Please ignore if returning the same day)
Return Time: *
Standing Reservations (Maximum 6 month in advance)
Please enter the starting date above first!     see calendar utility
->
Month Choose Related Dates Year Comments

AV Equipment Required?
(for internal use only)

Computer Projector
Other AV Equipment
Used in what room: *


Any other pertinent
information or requests.


Please Note: If you require an installation
please call (514) 398-5767 to make support reservations!

Secondary Support (514)398-3193

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