I, _______________________________________________________________________ (PRINTED NAME), agree that by signing this form I am checking out the Sony Microcassette-corder M-450 owned by Student Publications. This checkout includes:

_____ Sony Microcassette-corder M-450, which retails for $
_____ (4) Energizer Rechargeable AA Batteries, which retail for $
_____ micro-cassette, which retails for $

DATE of CHECKOUT

   This equipment should remain in your possession from __________________ (date) to ___________________ (date). After this time, all items must be returned to Dr. Sitton's office in Wells 110 (not to The Voice's office).

REIMBURSEMENT:

   If lost or misplaced during my checkout, I understand I am responsible for reimbursing Student Publications $________ (total price) for the equipment within 30 days of the agreed check-in date. Otherwise, the matter will be transferred to Academic Affairs and University counsel. _______ (please initial). 

ACKNOWLEDGEMENT OF RESPONSIBILITY:

Signed _________________________________________________   Date _________________________________

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