This request form must be filled out completely - including signatures. There is a TWO events/applications per calendar year limit for each organization and/or target audience. Include processing fee of $50 per speaker AND $50 per program - no limitation on the number of speakers and/or programs. For example, 2 speakers each doing 2 programs (4 programs total) would cost your organization $300 (2 x $50 + 4 x $50 = $300). Form and payment must be submitted at least 30 days before the program date.
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!
If you are making an online payment, you will be directed to that page after clicking "Submit" above. Your application will not be saved until you click "Submit."