Black History Month 2021 Contact Form Interested in having the NC African American Heritage Commission at your event? Please complete this form to request the NC African American Heritage Commission’s presence at your Black History Month event. *Speakers/Attendance available at the discretion and scheduling availability of staff. Please submit requests no later than December 18, 2020. Indicates required field Name of Organization Contact Name First Name Last Name Telephone Number Type - Type -HomeOfficeCell Phone Ext: E-mail Request Date and Time Request Date and Time: Date Request Date and Time: Time Location Address Address 2 City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Brief Description of Request Type of Event Lecture Cultural Celebration Performance Ceremony/Gala Radio/TV/Podcast Interview Other… Enter other… Does your event relate to one of the following AAHC initiatives? Freedom Roads/NC Freedom Seeking History Africa to Carolina NC Green Book Project She Changed the World:North Carolina Women Breaking Barriers Come Hear NC NC Civil Rights Trail Type of Request Speaker/Presenter Participant (Information Table) Attendance
Black History Month 2021 Contact Form Interested in having the NC African American Heritage Commission at your event? Please complete this form to request the NC African American Heritage Commission’s presence at your Black History Month event. *Speakers/Attendance available at the discretion and scheduling availability of staff. Please submit requests no later than December 18, 2020. Indicates required field Name of Organization Contact Name First Name Last Name Telephone Number Type - Type -HomeOfficeCell Phone Ext: E-mail Request Date and Time Request Date and Time: Date Request Date and Time: Time Location Address Address 2 City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Brief Description of Request Type of Event Lecture Cultural Celebration Performance Ceremony/Gala Radio/TV/Podcast Interview Other… Enter other… Does your event relate to one of the following AAHC initiatives? Freedom Roads/NC Freedom Seeking History Africa to Carolina NC Green Book Project She Changed the World:North Carolina Women Breaking Barriers Come Hear NC NC Civil Rights Trail Type of Request Speaker/Presenter Participant (Information Table) Attendance
