History Makers Travel Stipend and Hotel Reimbursement Application
Name
*
First Name
Last Name
Organization
*
Please enter the applicable mailing address for reimbursement, organization or home address.
Organization Mailing Address
Street Address
Street Address Line 2
City
State
Zip Code
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
I am interested in applying for:
*
Hotel reimbursement only
Travel stipend only
Both hotel reimbursement and travel stipend
My museum is located in a county with a population of under 50,000
*
Yes
No
County
*
My museum is located 60 miles away or more (one way) from the Kansas Museum of History in Topeka.
*
Yes
No
I understand that I must submit an HK travel form and receipts to receive the reimbursement and stipend. Payment will not be issued until after the Summit.
*
Yes
No
I understand that there is only one hotel reimbursement and/or travel stipend per organization.
*
Yes
No
I understand that Humanities Kansas will issue payment through bill.com and that my organization will be asked to create a bill.com account for this purpose.
*
Yes
No
Submit
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