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Fill and Sign the Speaker Request Form for Justices or Judgesnebraska

Fill and Sign the Speaker Request Form for Justices or Judgesnebraska

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SPONSOR ’S FORM TO REQUEST SUPREME COURT JUSTICE OR O THER STATE JUDICIARY MEMBERS AS FACULTY For individuals requesting representatives of the Nebraska judiciary as faculty. You may contact the Justice/Judge directly or use the following form for assistance. 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 Ot her: Program Time: P hysical Address & City: Nature of the Audience: Cost to attendees: SEND THE COMPLETED FORM TO: NS C Attorney Services Division 3806 Normal Blvd Lincoln, NE 68506 HELP DESK: 402.471.3137; fax: 402.471.2512 Em ail: nsc.attrservices@nebraska.gov Nebraska Supreme Court Speaker’s Bureau ASD 3:03 Rev. 11/17

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