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Historical Society of New Mexico - Plaques Application

Name of registered property, state register number, date of construction (if known) and any other pertinent information (for best effect limit narrative).  Plaques are 25 words more or less.

 ____Member $200    ____Non-member $225

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SR # _______________  Date Built ________________  Historical District Name ____________

Mounting:  ____Double Sided Tape or ____Blind Tapped ____Stucco "hanging cleets" add $20

Owner's Name and Address: 

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Street Address for USPS Delivery + telephone number:

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   Check or money order must accompany each order, payable to the Historical Society of New Mexico.  Submit separate order forms for each plaque requested.  The plaques are manufactured from aluminum alloys with flint hardness which gives them a scratch resistant surface.  The finish is bronze background with gold colored lettering.  They are 10" x 10".