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FORM FOR LENDING
UEA MEXICAN SOCIETY MATERIALS

Instructions: Fill the form with your details. Then select the PRINT button below and print a hardcopy to be signed. After that select the SUBMIT button. If you do not select both buttons we will be unable to process your request. Form MUST be signed when lending and when returning materials.
You must submit the request at least 24 hours in advance!

I/WE wish to request that the items described below, belonging to the
UEA Mexican Society be lent to ME/US.
I/WE declare that one of the following applies to me:

I am a member of the UEA Mexican Society:

YES NO

I represent the Committee of a fellow UEA Club or Society:

YES NO

These items are lent with the understanding from the receiving party that they are to be returned in their entirety and in GOOD working order. If items are missing or are found to be broken the person named below (either UEA Mexican Society Member or representative of the Committee of a fellow UEA Club or Society) is responsible for paying the equivalent value of a replacement.

Forename(s):

Surname (First):

Surname (Second):

UEA Registration #:

Club or Society:

REQUESTED

LENT

RETURNED

    Speakers

Speakers

Speakers

    Amplifier

Amplifier

Amplifier

    Amplifier power source

Amplifier power source

Amplifier power source

    Mini-plug to RCA cable

Mini-plug to RCA cable

Mini-plug to RCA cable

    Speaker to amplifier cable

Speaker to amplifier cable

Speaker to amplifier cable

 


________________________
President MexSocUEA

________________________
Requesting Party



 

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Modified on 03/ March / 2007