Organization requesting talk:
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:
Hotel/Motel (No private home accommodations, please)
(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 firstname.lastname@example.org
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