FORM ATV-04 – EQUIPMENT RENTAL REGISTRATION

Revised October 14, 2008

ALL INFORMATION IS REQUIRED FOR APPROVAL. INFORMATION INCORRECTLY ENTERED WILL AFFECT APPROVAL OF EQUIPMENT RENTAL. :

Name ______

Address ______City ______State ____ Zip ______

Address (off-campus) ______City ______State ____ Zip ______

Phone ( ______) ______- ______/ E-Mail ______

Are you currently a member of ATV? (circle choice) YES / NO UAlbany ID # ______

Do you currently have technical and equipment certification (“ATV-05 CERTIFICATION OF ABILITIES”) to use and operate ATV-owned equipment? (circle choice below)

YES / NO - Ifno, please note, while strongly suggested that ATV-05 be filled for your benefit, that completion of ATV-05 will not affect approval in the event that the project listed is not a recognized ATV program, collaboration and/or project.

Are you a member of a recognized student group? (circle choice) YES / NO

If yes, name of group. ______

Academic Year (e.g. Freshman, Senior) ______

Major ______Minor (if any) ______

Describe the project you will be request equipment for (e.g. event, programming, conference):

______

When will you need the equipment? ______

Date of Rental ______to ______

Please check off the equipment you will need (ATV will specify exact equipment used):

CAMERA (Quantity? ____ ) / S-VIDEO CABLE (Q? ____ ) / SWITCHBOARD
TRIPOD (Quantity? ____ ) / MIC CABLE (Q? ____ ) / WIND SCREEN
MICROPHONE (Quantity? ___ ) / DV TAPES (Q? ____ ) / This space is intentionally blank.

Will you need technical assistance or guidance from a member of ATV? (circle choice) YES / NO

Additional Required Content on Back

Please note and initial the following policies:

ATV N-05 Acknowledgement of Cost Notice (rev. 10/14/2008) : Albany Student Television (ATV) is a service of Student Association of the University at Albany, SUNY. By reading this notice and signing below on the form, you (“the applicant”) acknowledge that the various pieces of equipment that ATV owns carries significant financial risk in the event of equipment damage and/or destruction as noted in the Equipment Liability Notice (“ATV N-03”) and may be financially significant to certain individuals and recognized student groups.PLEASE INITIAL FOR ACKNOWLEDGEMENT HERE _____

ATV N-04 Priority Usage Notice (rev. 10/14/2008) : Albany Student Television (ATV) is a service of Student Association of the University at Albany, SUNY. ATV reserves the right to be priority user for all equipment ATV owns and operates. All applied individuals and recognized student groups apply with ATV with the acknowledgement that their application for equipment rental may be rejected due to previously scheduled planning by either ATV, an individual user, and/or a recognized student group.PLEASE INITIAL FOR ACKNOWLEDGEMENT HERE _____

ATV N-03 Equipment Liability Notice (rev. 10/14/2008) : Albany Student Television (ATV) is a service of Student Association of the University at Albany, SUNY. Registered equipment owned and on record by ATV may be requested by certified students (“individuals”), student groups (“recognized student groups”), Student Association (“SA”) and members of ATV only. Equipment is to be picked up at the designated time and returned to ATV at the designated return date and time in the same condition as received. In the event that equipment has been damaged and/or lost, the individual and/or recognized student group is responsible of replacing said equipment in a timely fashion. In the event that the equipment was requested by a member of Student Association for an affiliated event or project and has been damaged and/or destroyed during the said time of request, Student Association is responsible for replacing the equipment at the cost of the user unless a waiver is granted by the Director of Albany Student Television only. In the event that a member of ATV damages and/or destroys equipment requested, the individual member is responsible for replacing equipment at the cost of the user unless a waiver is granted by the Director of Albany Student Television. Individuals and recognized student groups may apply for general liability insurance through domestic third party insurers and/or Student Association’s insurer, Travelers ( to protect equipment for time period granted for equipment usage. If the individual and/or recognized student group goes through Travelers, applicants must fill out the Risk Management Assessment through the Office of the Comptroller of Student Association (the form may be downloaded online at or picked up in Campus Center 116 – the Student Association office). Applicants for general liability insurance must list Student Association and/or ATV as an additional insured party in the event of third party usage. Waivers for damaged and/or destroyed equipment may only be granted by the Director of Albany Student Television at their discretion. PLEASE INITIAL FOR ACKNOWLEDGEMENT HERE _____

ATV N-02 Ethical Failure Advisement Notice (rev. 10/07/2008) : Albany Student Television (ATV) is a service of Student Association of the University at Albany. ATV is not responsible for ethical failures of member personnel in producing programming which may be deemed inappropriate for broadcast on UATV (University Television), our on-campus broadcasting partner. In the event that ethical failure is executed, the ATV member will be revoked of privileges associated with ATV and up to and not limited to revocation of the ability to pursue additional extracurricular student activity by a functioning, recognized organization which receives funding through Student Association.PLEASE INITIAL FOR ACKNOWLEDGEMENT HERE _____

ATV N-01 License Adherement Notice (rev. 10/06/2008, 2nd rev. 10/14/2008) : Albany Student Television (ATV) is granted licenses (“ATV-02”) from all individuals whose likeness is used on programming produced or partnered with ATV. This license will valid for a period of one year from the submitted date in which ATV may use all categories for the licensor for both ATV in-house and APUs. After one year, only content developed by ATV in-house shall remain licensed. The licensor will receive one copy of their license and Albany Student Television is required to retain all licenses for an indeterminate period of time. Members of ATV using the licenses must adhere to the Ethical Failure Advisement Notice.PLEASE INITIAL FOR ACKNOWLEDGEMENT HERE _____

Should you have any questions or concerns about the form and/or its policies and practices listed, you may contact Joe Bonilla, the Director of Albany Student Television and/or John Dias, the Assistant Director of Albany Student Television via e-mail at or by phone at (518) 442-5628.

Thank you for your interest in broadcasting the world within, Albany Student Television.

PRINTED NAME OF APPLICANT / SIGNATURE / DATE SIGNED AND SUBMITTED
PRINTED NAME OF ATV OFFICIAL / SIGNATURE / DATE SIGNED AND FILED

Albany Student Television. “Broadcasting the World Within.” 1400 Washington Avenue, Albany, NY 12222.

ALBANY STUDENT TELEVISION OFFICE USE ONLY
Name of Official ______Position ______
Application Approved? (circle choice) YES / NO If no, why? ______
Date of Equipment Pick Up ______Is this the same as requested? YES / NO
Date to be Returned ______Is this the same as requested? YES / NO
Listed exact equipment picked up and condition.
On return, did the applicant return items in full and original condition? (circle choice) YES / NO
If no, please state condition ______