First Amendment Activity Permit
Hall County Airport Authority │Central Nebraska Regional Airport
Organization Name
*
Organization Name or N/A if not applicable
Organization Address
*
Mailing Address
Mailing Address Line 2
City
State
Zip Code
Contact Name (will be present during activity)
*
First Name
Last Name
Contact Phone Number
*
-
Area Code
Phone Number
Contact Email
*
example@example.com
Contact Address
*
Mailing Address
Mailing Address Line 2
City
State
Zip Code
Proposed Activity & Purpose Statement
*
Nature, purpose, and subject matter of proposed activity
Number of Participants
*
Please Select
1
2
3
4
5
Max of 5
Activity Date
*
-
Month
-
Day
Year
Date
Activity Start Time
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Activity End Time
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Legal Status of Organization or Individual
*
i.e., a natural person, partnership, corporation, association, or other organization
Has the applicant (including all partners, officers, directors or trustees thereof) or its agents had a prior permit revoked for violation of the Free Speech Policy?
*
Please Select
Yes
No
Choose One
Signature
*
Enter the message as it's shown
*
Date/Time Application was Submitted (office use only)
Submit
Print Form
Hall County Airport Authority │3579
Sky Park Road │ Grand Island, NE 68801 │ (308) 385-5170
Should be Empty: