I, ___________________________________________________________ (PRINTED NAME), agree that by signing this form I am checking out the lab key owned by Student Publications. This checkout includes:
_____ (1) lab key, which retails for $10.
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).
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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©UAM Student Publications 2012
Revised 082012 — http://www.uamont.edu/Organizations/TheVoice/sm/key.htm