Audio Visual Signature Authorization Form

An individual's signature is required to check out items from the Audio Visual Services department; however we understand that visiting us in person may occasionally be a struggle. By completing the form below, you are granting the individual you identify permission to sign in lieu of your own signature. You take full responsibility for any damage due to neglect or abuse, accidental or otherwise, from pickup to return. You also agree to cover all charges accordingly for repairs or replacement as necessary, and any fines associated with untimely pickup or return. All other terms, warnings, and policies apply as posted.

Your Network Username
 Network Username of individual you are authorizing

* Items to be picked up: (Please check all that apply)
Media title(s)
 Equipment previously reserved for pickup on

* - Required