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Media Reservation/Request Form

* indicates a require field  

*Full Name:

Event Contact Person:
(if different from person making reservation)

(if employed elsewhere provide company/college name)

*Phone # or RVCC extension:

RVCC email:

Other email:



Event Location:
(building & room name/number)

Event Date:

Start Time:

include am/pm

End Time:

include am/pm

please check here if this is a
RECURRING reservation:
(every week, same day/time/room for full semester)


if you selected recurring, please indicate an End Date
when we should stop providing equipment:

Equipment List:  
if you need more than one of something checked above (like easels or mics), please indicate item and quantity:
additional request/comments:



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