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Fill and Sign the Nebraska Supreme Court Speakers Bureau Form

Fill and Sign the Nebraska Supreme Court Speakers Bureau Form

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SPONSOR ’S FORM TO R EQUEST JUDICIAL B RANCH FACULTY For groups requesting representatives of the Nebraska Judicial Branch (including administrative officers , Probation and Court staff) as faculty. PART A: SPONSOR CONTACT INFORMATION The name of the person completing this form should be listed in this section as the contact person. Sponsor Name: Contact Person : Request Date: Address: City State ZIP Email: Phone: PART B: PROPOSED OR REQUESTED JUDICIAL BRANCH FACULTY (If known) Indicate the member or members of the Nebraska Judicial Branch requested as faculty at the program detailed below in Part C. Name Court or Office 1. 2. 3. PART C: PROGRAM INFORMATION , LEARNING OBJECTIVE & ADDITIONAL INFORMATION Description of the program. Include a timed agenda for the program with this request form. Program Title: Requested C ontent: Learning Objectives (if set) : Type of CLE Activity: Lecture Program Date: O nline or Webinar SEND THE COMPLETED FORM TO: NSC Attorney S ervices Division 3806 Normal Blvd Lincoln, NE 68506 HELP DESK: 402.471.3137; fax: 402.471.2512 Ema il: nsc.attrservices@nebraska.gov Nebraska Supreme Court Speaker’s Bureau Cost to attendees: Nature of the Audience: Physical address: Other Presentation Time: Location (City): ASD 3:02 Rev. 11/17

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