New Mexico Tumor Registry Information Request Log
NMTRWEB HOME Please print and complete the form fields provided and submit your request to: The New Mexico Tumor Registry MSC 11 6020 1 University of New Mexico Albuquerque, NM 87131-0001
Date / Time Received (mm / dd / yyyy) Summary	Institution Name Mailing Address Phone FAX# Email		Cancer cluster/epidemic? Yes No If Yes, enter NM County for area of interest: County Cancer primary sites(s) / type(s) 1) 2) 3) 4)