Audience Response Reservation Form

Name *
EN # *
Email
Department/Program
Purpose/Program
if other, please specify
Cost Center
For damaged, lost or unreturned items
Location
Date & time for pick-up *

MM
/
DD
/
YYYY

HH
:
MM

AM/PM
Date & time for returning *

MM
/
DD
/
YYYY

HH
:
MM

AM/PM
Number of Transmitters needed *
(limit 60)
Person authorized to check-out the unit
must present baystate id badge at pick-up time

Audience Response Reservation Process/Guidelines

Submission of the form signifies your agreement with the following:

I agree to return the unit on or before the date and time it is due.
I agree to return the unit in the same condition as I received it.
I agree that damaged or lost equipment will be charged to the cost center I provide on the Reservation Form. The charge is $80 per damaged or lost transmitter and $750 per damaged or lost receiver.
I agree to cancel my reservation if I will not be needing it by notifying the library 24 hrs. in advance.
I understand that nonadherence to this agreement means that my department/division/program may lose the privilege of using the Turning Point Audience Response system.
Once the library receives your Reservation Form, they will email you a notification of confirmation or scheduling conflict.

It is recommended that first-time users visit the Health Sciences Library at least 1 day before their reservation to test the unit with the PC they plan to use.

The unit must be picked up at the Health Sciences Library by the faculty member who reserved it or his/her designee.
The unit may be picked up 1 hour before the session. It must be returned by ½ hour after the session.

When the unit is checked out, the Reservation Form must be signed by the person picking it up.
When the unit is returned, the Reservation Form will be signed by a Library staff person and the form returned to the user.

For Library use only

Unit Checked out by:
Print Name
Signature
Unit Returned to
Date/Time Returned
Checkbox
 First option 
 Second option 
 Third option