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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
P. O. Box 1912
Santa Fe, NM 87504-1912

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

Historical Society of New Mexico
P. O. Box 1912
Santa Fe, New Mexico  87504
hsnminfo@hsnm.org