PBG Campus Media Technology & Instructional Services Online Request

561-207-5815

This form has been designed for advanced booking requests only. Please give us at least 24 hours (not including weekends and holidays) to process your request.  Channel assignment for CCTV requests will be emailed to your PBCC email address.

By submitting this request, I certify use will be incompliance with existing Copyright Laws and accept liability for any infringement incurred by its use.

  Email   Address @pbcc.edu

Contact 
Phone Number
                           (optional)

 Equipment Request
 		    
  Portable data projector with computer
 		 Slide projector
 

     Other - Please identify other

 Location of use  
 


 

    

Date of use  
  

    Month:     Day:      Year:
 

Beginning  

   am pm
(time)                               

     

 Ending

      am pm
       (time)                              
 
   Reservation Request      

  These items will have to be signed for, picked up and returned to MTIS office (LL106).
  These items may be checked out for up to seven days.

 Date of pick-up   
  

    Month:     Day:      Year:
 

Pick-up time:

   am pm
(time)                               
 		  

 DV camcorder

  

 with Tripod
 

 Digital Camera

    
 

 Boom Box

  

 Laptop
       

  Videotape/DVD 1 -  A/V number  

 
 

 Title  

 

  


Videotape/DVD 2 -  A/V number  

 
 

 Title  
 

  

 

  CCTV Request
 		    

Date for Playback  

   Month:     Day:      Year:
 

 A/V number  

Title 

  
       

 Exact Times to start    am pm
                                              (time)
 

  

 Exact Times to start   am pm
                                              (time)
 

  

 Exact Times to start   am pm
                                              (time)
 

  

 A/V number  

Title 

  
       

 Exact Times to start   am pm
                                             (time)
 

  

 Exact Times to start   am pm
                                              (time)
 

  

 Exact Times to start   am pm
                                    (time)
 

 


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