Instructional Technology Video Production Work Request

Personal Information

Contact / Person Requesting:

E-mail:

Phone / Extension:

Office Location:

Event Name:

Event Location:

Special Guests / Titles

Event Details

Event Date:

Event Start Time:
Hr Mins AM/PM

Event End Time:
Hr Mins AM/PM

Services Requested

Product Details

Final Format:

Multiple Copies Required?

Yes

Number of Copies Required:

POETS Info

P:
O:
E:
T:
S:
Total Cost:	*

*First copy free, $2.00/copy thereafter.

Due Date

Would you like the Master tape returned to you?

Yes

I understand that submission of this form is merely a request for services to be rendered and in itself, is in no way a gaurantee or committment on the part of Media Services to provide the requested service.

Upon submission of this form, the area production personnel will contact you to obtain further information and discuss event or request details.

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