Checking this box is my electronic signature and I agree to return the items in the
condition they were checked out on or before the date stated above. If I fail to do
so, I and/or my department will forfeit the privilege of checking out items from the
CHSE Offices of Professional Education, Communications, Advocacy & Outreach and bear
the financial obligation for replacing the items.
Please indicate which items you would like to request and the quantity.
Please note: Items are loaned on a first-come, first-served basis.
We recommend filling out this form as soon as you know the date of your event.