REQUEST FOR A LECTURE
PRESENTED BY DR. EVAN DAVIES

Organization requesting talk: 

Contact Person: 

Address:

Phone:

Email: 

Event Date[s]: Event time:

Location: (City) (State)

Maximum length of presentation:

Anticipated number of attendees:

Is your organization: for-profit            non-profit

The following will be paid by the host organazation:

Travel

Mileage ($.51/mile)
Air fare
Shuttle

Accommodations

Hotel/Motel (No private home accommodations, please)
Meals

Honorarium Amount:
(Payable to IHSF)

Will the above be direct payments or reimbursements?

To whom should receipts for reimbursements be sent?

Topic of Speech:

Please print this form and mail to the address below:

P.O. Box 36 Mesilla Park, New Mexico 88047 U.S.A.
Telephone: 575.525.3035 Fax: 575.525.0106 info@ihsf.org

Back to Home