NMCIR Event Request Form

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Please fill out this form to the best of your ability for an initial event request.

Name *

Organization/School/Hospital Name *

Position *

Email *

Phone Number *

Address (where the event will take place) *

Proposed Dates & Times *

Focus of the Event (i.e., Executive Orders, Know Your Rights Training) *

Population (who will be attending; i.e., parents from PTA, advocates, health care practitioners, etc.) *

Number of attendees? There is no minimum. *

Please select your language of preference for the presentation. *

English

Spanish

Required

Can you provide a projector, screen and laptop for the presentation? *

Yes

How did you hear about NMCIR?

Elected Official

Hispanic Federation

Radio

Television

Word of Mouth/Friends and Family

Internet Search

Other:

Clear selection

Can we send you email notifications of future events? *

Yes

Thank you for contacting us!

NMCIR's goal is to serve everyone who sends us an event request. You should receive an email confirmation within 24 hours. If you don't, please email yestevez@nmcir.org.

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