First Year Free Opt-In Form - Nebraska

This form does not require you to have made final decisions regarding your 2025 programming but starts to set the stage so BetterCulture can set you and your program up for success. Please share as much information as you can and know that you can update this information at any point.

First name*

Last name*

Email*

Company name*

Job title*

City*

State/Region*

Estimated Population of Your Community*

What BetterCulture program type(s) are you planning to implement in 2025?*

Which BetterCulture products are you planning to utilize?*

When will your BetterCulture program(s) start?*

How many participants are you hoping to recruit for your program(s)?*

What will you charge for your program participation?*

Do you have a coordinator identified?*

If yes, what is the coordinator's name?

If yes, what is the coordinator's email?

Do you have a facilitator identified?*

If yes, what is the facilitator's name?

If yes, what is the facilitator's email?

Anything else you would like us to be aware of?