| * | Date when the proclamation is needed: | *Required |
| * | The name proclamation: | *Required |
| * | Date(s) of the day, week, or month, to be proclaimed: | *Required |
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| * | Has this proclamation been issued in NM in the past? | *Required |
| If so, when? | |
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| * | Is this in conjunction with a National Recognition? | *Required |
| If so what States issued this proclamation this year? | |
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| * | Will the proclamation be presented at an event? | *Required |
| If so, provide details of the event (itinerary, attendees, etc.) | |
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| * | A summary and background of the requesting organization: | *Required |
| * | Requesting organization's web site: | *Required |
| * | What additional groups are involved? | *Required |
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| * | Is Honoree named in proclamation text? | *Required |
| If so, please provide Honoree's Name: | |
| Background of Honoree, if named in proclamation text: | |
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| Proposed text for the proclamation, including 4-6 “Whereas” clauses: *Draft language provided may be edited or rewritten at the discretion of the Governor’s office. | |
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| * | Name: | *Required |
| * | Phone: | *Required |
| * | Email: | *Required |
| * | Address: | *Required |
| * | City: | *Required |
| * | State: | *Required |
| * | Zip: | *Required |
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| * | Organization: | *Required |
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| * | How would you like to get the completed proclamation? | *Required |
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| * | I have read and agree to the proclamation terms & conditions. | *Required |
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