Equipment Request Form

Please copy and paste this information to submit your request.  As noted below, you may submit either an electronic or hard copy of this form.

SCSECS 2012 Equipment Request Form

Presentation Title: ________________________________________

Your Name: _____________________________________________

Email Address: ___________ Telephone: _________ Fax: _______

Please provide the following information:

I will require the following presentation equipment:

LCD Projector and Screen

I will require the following presentation equipment not listed above:




Please contact Dr. Phyllis Thompson if you have any questions or need more information.

All speakers are requested to complete this Request for Equipment Form by January 20, 2012, and return it to Dr. Phyllis Thompson at or Department of Literature and Language, ETSU, Box 70683, Johnson City, TN 37614.  We will do our very best to accommodate your request.