Date of Request:

Name:                         Department:

Phone Extension: 

Email Address:

Date of Event:

Time of Event:

Location of Event:

Projection Description: (Attach scripts, outlines, and location)

Project Purpose: (Include desired title and lengths)

Desired Date of Competion:

The Media Center webcasts selected productions over the internet via the ASU/University Library's website. By signing below you grant us the right to webcast this production.

Requestor Webcast Authorization:    You have my permission to webcast. You do not have my permission to webcast. <\SELECT>                                          

Speaker/Group Representative:

Please Note:  If you do not receive a confirmation or follow-up call within 24 hours of request submission, please contact: Library Media Services at 229-5605.