Program Partnership Request Form
For individuals or organizations requesting to work with JMRL staff to present or partner on a program.
[JMRL Form 4.38]
Description and format of the program *
Your answer
What will people learn from your program? *
Your answer
Target audience and age group *
Your answer
Preferred days and/or times for your program. *
Your answer
Please check the locations where you would like to present the program. *
Required
Please indicate what size room you'll need and any technology requirements or other considerations. *
Your answer
What is the projected cost (honorarium, supplies, etc)? If no charge, enter N/A *
Your answer
Please provide a summary of presenter's qualifications. *
Your answer
Please list other venues where you have presented.
Your answer
How does this program support JMRL's mission statement that the "Jefferson-Madison Regional Library enhances the quality of life by providing equal access to information. The Regional Library serves all ages, promotes reading, serves as a life-long educational resource, and supports democracy by fostering the free exchange of ideas?" *
Your answer
Your Name *
Your answer
Organization Name (optional)
Your answer
Organization Website (optional)
Your answer
Phone Number *
Your answer
Address *
Your answer
Email *
Your answer
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This form was created inside of Jefferson-Madison Regional-Library.