FORMER Request for Campus Memorial Plaque
Request for Campus Memorial Plaque
Requestor's Name ________________________________________________________
Address ________________________________________________________________
Street City State Zip
Phone (work) _________________________ (home) ____________________________
Name of Honoree (as you wish it to appear) ____________________________________
__________________________________________ _________________
Requestor's Signature Date
Please make check for $25 payable to the CNM Foundation Campus Memorial Fund.
Submit form to: Or fax to:
Communication Officer, (505) 224-4417
CNM Public Information Office
525 Buena Vista SE
Albuquerque, NM 87106