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COMPLETION FORM for the Host Organization Note to the Local Historical Society (Host Organization): In order for the Speaker to receive the Honorarium from HSNM, you must provide the information indicated below and send the completed form to: Speakers Bureau-HSNM Note to the Speaker: Please be sure the Host Organization completes a copy of this Form and submits it to HSNM. Remember, the group that invites you must be a current member of HSNM in order for you to receive your Honorarium.
Name of Organization: _________________________________________________ Mailing Address of Organization: ________________________________________ Date of Presentation: __________________________ Place Presentation Delivered: ______________________________ Name of Speaker: _______________________________ Title of Presentation: _______________________________________ Approximate number of attendees: _____________ Brief evaluation of the presentation by the Host Organization: Signed by Host Organization: ______________________________________ Please return promptly to: Historical Society of New Mexico
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Historical Society of New Mexico P. O. Box 1912 Santa Fe, New Mexico 87504 hsnminfo@hsnm.org |
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