Purchase Order Form

Purchase Order Form

Please provide the following information for your PO, once you submit the form we will reach out to the contact to send an invoice for the requested registrations.

Contact First Name: *

Contact Last Name: *

Contact Email: *

Organization/Senior Center Affiliation:

Mailing Address: *

City: *

US State: *

Zip / Postal Code: *

Phone: *

Release Form

Please check one box: *

I agree to the following terms:

I don't agree to the following terms:

I, agree to allow The New Mexico Aging and Long-Term Services Department to release my name, address, and email address to exhibitors/sponsors and/or workshop presenters.

I hereby release, discharge, and exonerate the New Mexico Aging & Long-Term Services Department from any and all liability of every nature and kind arising out of the furnishing, inspection, and use of all released documents, records and other information, and this release shall be binding on assignees.

Please choose the amount of registrants (tickets) you would like for each category below:

Age 55+ Seniors/Family Caregivers/Adult with Disability ($12 each):

Senior Service Providers ($35 each):

CEU Credit ($55 each):

Once you click submit, a member of ALTSD will be notified. They will contact you for a list of names of those you wish to pay for via your Purchase Order and provide an estimate to you for the amount requested so you can obtain your Purchase Order. If you need more assistance with paying with a Purchase Order, please email us at altsd.coa@altsd.nm.gov or call us at (505) 316-0164.

By submitting this form, you are agreeing to receive communications from the New Mexico Aging & Long-Term Services Department.