Your Organization's Name

Primary Contact and Title

Name on Contract:

Address

City State Zip

Organization's Phone Organization's Fax Number

Organization's Email

Estimated Date (if unknown please give range of dates)

Estimated Total Attendance During Event/s

Estimated Time of Arrival Estimated Time of Departure

Which Rooms are you Requesting?

200B- Engagement Auditorium
200A - Simulation/Re-enactment Stage
300 - Jack Daniels Room
118A - Classroom A
118B - Classroom B
118C - Classroom C
114 - Computer Lab
Library

Audio / Visual Accomodations

Beverage or Food Accomodations (at additional costs)

Drink	Coffee Water Soda Other:	Drink Comment / Recommendation
Breakfast	Continental Full Breakfast Other:	Breakfast Comment / Recommendation
Lunch		Lunch Comment / Recommendation
Dinner		Dinner Comment / Recommendation
Snack Tray		Snack Comment / Recommendation
Catering Kitchen		Comment / Recommendation

Please Indicate Any Experiential Activities Requested (at additional cost)
High Ropes Low Ropes Cooperative Games Leadership Reaction Course

Would you like a Tour of NMMI? Yes No

Method of Payment Check Other

INSTRUCTIONS: Submit this form electronically, or print and mail or fax it to:

Daniels Leadership Center
New Mexico Military Institute
101 W College Blvd
Roswell, NM 88201

Fax: (575) 624-8318

Phone: (575) 624-8148

Campus Map and Travel Directions if needed

Any Other Comments: