This request form must be filled out completely - including signatures. There is a TWO application per calendar year limit for each organization and/or target audience. For first application include processing fee of $50 - or $75 for the following high use speakers: Jeff Barnes, Cherrie Beam-Callaway, Darrell Draper, Charlotte Endorf, Sue McLain, and Joan Wells. For second application, include processing fee of $100. Form and payment must be submitted at least 30 days before the program date.
Please include the name of building as well as a street address.
Home or organization address to which Humanities Nebraska should mail confirmation materials to you
I ASSURE THAT MY ORGANIZATION WILL:
I CONFIRM THAT:
Please complete this form entirely before making your payment. A link to the online payment system is available at the end of this form.
PLEASE MAKE CHECK OUT TO:
If you have any questions please contact our office by calling 402-474-2131 or emailing email@example.com. We are more than happy to provide any necessary assistance!