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 *
What will people learn from your program? *
Target audience and age group *
Preferred days and/or times for your program. *
Please check the locations where you would like to present the program. *
Please indicate what size room you'll need and any technology requirements or other considerations. *
What is the projected cost (honorarium, supplies, etc)? If no charge, enter 0 *
Please provide a summary of presenter's qualifications. *
Please list other venues where you have presented.
How does this program support JMRL's mission statement to "foster personal growth and life-long learning for all by connecting people with ideas,information, and each other." *
Your Name *
Organization Name (optional)
Organization Website (optional)
Phone Number *
Address *
Email *
Never submit passwords through Google Forms.
This form was created inside of Jefferson-Madison Regional-Library.