Political Activity Notification Form

(please print)

_____________________________________, representing _____________________________,
candidate, organization, issues, etc.

has notified the CNM Public Information Office of intent to visit ____________________________
room/building

at _____________________________________ Campus on _____________________________
campus date(s)

during the hours of ______________________.

MCO Representative _____________________________________________________________
name signature date

POLITICAL ACTIVITY

Name(s) of visitor(s) ____________________________________________________________

Political office/issue ____________________________________________________________

Purpose of visit ________________________________________________________________

CNM sponsors name and phone number (if applicable) _______________________________

Date(s)/time(s) of visit(s) ________________________________________________________

___________________________________________________________________________

Course title (if applicable) ________________________________________________________

Location of activity _____________________________________________________________

List any special needs: ________________________________________________________

____________________________________________________________________________

___________________________________________________________________________

Please submit samples of any materials to be distributed (optional).

XC to: Visitor

VP for Administrative Services

Security