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 firstname.lastname@example.org. We are more than happy to provide any necessary assistance!