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NMCIR Event Request Form
Please fill out this form to the best of your ability for an initial event request.
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* Indicates required question
Email
*
Your email
Name
*
Your answer
Organization/School/Hospital Name
*
Your answer
Position
*
Your answer
Email
*
Your answer
Phone Number
*
Your answer
Address (where the event will take place)
*
Your answer
Proposed Dates & Times
*
Your answer
Focus of the Event (i.e., Executive Orders, Know Your Rights Training)
*
Your answer
Population (who will be attending; i.e., parents from PTA, advocates, health care practitioners, etc.)
*
Your answer
Number of attendees? There is no minimum.
*
Your answer
Please select your language of preference for the presentation.
*
English
Spanish
Required
Can you provide a projector, screen and laptop for the presentation?
*
Yes
No
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
No
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
.
A copy of your responses will be emailed to the address you provided.
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