Kickstart Payment Form

Schools/Organizations

Please fill out the following form. When complete, you may hit the "print" button at the bottom of the form PRIOR to submitting the form if you need documentation for an invoice. If you forget, you may send an email to ashley.orcutt@nebraskaleadership.org and she can send you a pdf version of your completed form.

If your school or organization cannot make an electronic form of payment, please reach out to ashley.orcutt@nebraskaleadership.org for assistance in paying via check.

Parents/Guardians

Please fill out the following form and proceed to pay via PayPal.

I am a...*

School or Organization Paying for DelegatesParent/Guardian Paying for Delegates

DELEGATE COST

The cost to attend NLS Kickstart is $50.00 per delegate. You can pay via credit card or an electronic check (e-check users must have a PayPal account) via the PayPal module at the end of the form.

PLEASE NOTE

All payments must be received by May 21, 2025.

If you believe that your school or a local service club has paid or will be paying the tuition fee, please contact them as soon as possible. Tuition must be paid prior to participation.

Organization, School, or Person Sponsoring Delegates*

Sponsor Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Contact Person*

First NameLast Name

Sponsor Phone Number*

Sponsor Email*

example@example.com

Parent/Guardian Name*

First NameLast Name

Parent/Guardian Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Phone*

Parent/Guardian Email*

example@example.com

How many delegates are you sponsoring/paying for?

First Delegate Name*

First NameLast Name

Second Delegate Name*

First NameLast Name

Third Delegate Name*

First NameLast Name

Fourth Delegate Name*

First NameLast Name

Fifth Delegate Name*

First NameLast Name

Sixth Delegate Name*

First NameLast Name

Seventh Delegate Name*

First NameLast Name

Eighth Delegate Name*

First NameLast Name

Ninth Delegate Name*

First NameLast Name

Tenth Delegate Name*

First NameLast Name

By clicking "Yes" below, I agree to pay $50 per delegate to attend Nebraska Leadership Seminar's July 2025 Kickstart Session. I understand that these payments are due by May 21, 2025 via the PayPal Registration System below.*

Yes

Payment Option*

PayPal - Credit Cards may be used without an account. E-checks require an account. Do not hit the submit button until you have selected the correct amount of delegate registrations and have entered a payment method.

PayPal Registration System

Delegate Registration

$50.00 Quantity
Item subtotal:$0.00

Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

2025 Nebraska Leadership Seminar Kickstart Payment Form