Center for Telehealth and Cybermedicine Research

Telehealth Conference Request Form

This form will send a request for a conference to the User Support Analyst. The Center for Telehealth will contact you concerning your conference and confirm the dates and times you have selected.  If you wish not to fill in this form please feel free to contact us at (505) 272-8633.

Please provide the following contact information:

Name
Title
Organization
UNM Dept.
Address
City
State
Zip
Phone
Fax
E-mail
URL
Conference Title:
Type of Conference:
Select any of the following that apply for Specialty:
(Press and hold Ctrl key while clicking to choose multiples)
Conference Date:
mm/dd/yy
Conference Time (MST):
Number of Participants at UNM:
Site Information
Please list all site information.
Site Name
Site Technical Contact
Site Technical Phone
Site IP Address
    or Site ISBN Number
Site Address