New Mexico
Environment Department

Contact Information:
(505) 827-2855 MAIN // 1-800-219-6157 (toll free)

Environmental Emergencies:
505-827-9329 (24 hrs)

Speaker Request Form

Please enter all information below

Completing this form does not commit the Department to a specific speaking engagement. Upon completion, the Public Information Officer will contact you with a a decision regarding your speaker request. For confirmed speaking engagements, the Department reserves the right to substitute an alternate speaker should a scheduling conflict arise beyond the control of the scheduled speaker. Thank you for your interest in having a speaker from the New Mexico Environment Department at your event! Please contact Maddy Hayden, Public Information Officer, at maddy.hayden@state.nm.us with any questions regarding this form.
Name of Requester*
First Last
Organization*
Title*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email*
Primary phone*
Event title*
Event website*
Presentation/Remarks themes:*
Date*
Date Format: MM slash DD slash YYYY
Time*

: Hour

Minute
Duration of event*
Is time flexible?*
- Yes
- No
Format*
(i.e., Panel, Keynote, Lunch Speaker, etc.)
Anticipated audience size*
Open to press*
- Yes
- No
Speaker requested:*
Is an alternate speaker acceptable?*
- Yes
- No
VIPs who will be attending this meeting*
(please list names, titles, and organizations represented):
Point of contact on day of meeting:*
First Last
Point of contact phone number:*
Email
This field is for validation purposes and should be left unchanged.