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 email@example.com 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 firstname.lastname@example.org or Department of Literature and Language, ETSU, Box 70683, Johnson City, TN 37614. We will do our very best to accommodate your request.