* = Required Field
	*Certified Producer Name:
	*Phone Number:
	*e-mail:
	*Project Title:
	NOTE: You must have a Project Proposal Form submitted for this project before making equipment reservations.
	*Date of Pick-up:
	*Time of Pick-up:
	*Date of Return:
	*Time of Return:
	*I Request:		ADDITIONAL EQUIPMENT
			Please list: List additional certified producers if requesting more than one camcorder:
			ADDITIONAL EQUIPMENT TIME
			Please list: Will this equipment be taken out of the CCTV service area (Salem/Marion County)?: No  Yes If yes, where: Estimated travel time:
			ADDITIONAL FACILITY TIME
			Please list:
	*Reason for your request:
	*Approximate number of program hours that will be produced from this request: