MASSACHUSETTS ENA AV EQUIPMENT LOAN AGGREEMENT

The following Audio-Visual (AV) equipment is available for loan from the Massachusetts
ENA State Council. This is a loan agreement between the Massachusetts ENA State Council
and _________________________________________________________________
for the loan of this equipment:


___ Overhead Projector

___ Clip-on microphone

___ Extension cord

___ LCD Projector

The above indicated equipment is being loaned to ________________________________
from _______________________________ to ______________________________
for use during the educational program _______________________________________
being held on __________________________________________________________
at __________________________________________________________________.

The contact person is ___________________________________________________,
representing __________________________________________________________.
Contact information:
Address: ______________________________________________________

_______________________________________________________
Phone: (home): ______________________ (work): ______________________
E-mail address: (home) __________________________________________
(work) ___________________________________________
Fax: (home) ___________________________________________
(work) ___________________________________________

By signing this agreement, the party receiving the indicated AV equipment in loan is responsible for returning the equipment in same condition in which it was received and on the agreed upon date.

________________________________________________
(person responsible for receiving the AV equipment)

________________________________________________ _________________
(Massachusetts ENA State Council representative) (date)

________________________________________________
(date of equipment return)