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Media Advance Booking Request Form

If you would like to reserve media materials for future use, please fill out the form below. When we receive this form, we will reserve the media materials for the dates you set, thus guaranteeing that nobody else will borrow them.

This will not pertain to media materials on reserve for a class.

If the requested material is not retrieved within 24 hours, we will put it back into circulation.

Please fill out the form as completely as possible.

Page 1 of 1

Requester's Name:

Department:

Campus Phone Number:

Email Address:

Course Number:

Course Title:

Request 1

Title of Media:

Call Number of Media:

Date of Use:

Pick-up Date

Date (mm/dd/yy):

Pick-up Time:

Return Date

Date (mm/dd/yy):

Return Time:

Request 2

Title of Media:

Call Number of Media:

Date of Use:

Pick-up Date

Date (mm/dd/yy):

Pick-up Time:

Return Date

Date (mm/dd/yy):

Return Time:

Request 3

Title of Media:

Call Number of Media:

Date of Use:

Pick-up Date

Date (mm/dd/yy):

Pick-up Time:

Return Date

Date (mm/dd/yy):

Return Time: