2021 NBNA Speaker Conference Registration Form | August 3 - August 8, 2021

National Black Nurses Association, Inc.

49th Annual Institute and Conference * Tuesday, August 3 - Sunday, August 8, 2021
2021 Speaker Registration Form
Please type or print: (printing must be legible)

ALL SPEAKERS MUST COMPLETE THIS FORM

Completion of this form confirms your participation as a speaker.

Form MUST BE SUBMITTED BY May 15, 2021.

All presenters are responsible for their own hotel reservations and expenses.

Click below to make your reservation at the Dallas Hilton Anatole:

Group Code: NBN

Booking Link: https://book.passkey.com/go/5cd78dec

The conference rate for accommodations ends, July 6, 2021.
Full Name*

First NameLast Name
Credentials*
NBNA Member?*
NBNA Chapter?*
Job Title*
Institution*
Street Address
Street Address 2
City
State/Province
Postal/ Zip Code
Phone Number*

Area CodePhone Number
FAX Number

Area CodePhone Number
E-mail*
Are you Under Forty?

YESNO
Are you an Advanced Practice Nurse?

YES
Discounted Speaker Registration fee of $350.00 includes 1 banquet ticket and 1 brunch ticket.

One Day Speaker Registration Fee is $150.00

This fee does not include Presidents Gala or Sunday Brunch tickets.

NBNA’s COVID-19 Cancellation Policy

Should NBNA be unable to host a live conference August 3-8,2021 due to COVID-19, all registrants will be notified immediately. The following options will be offered to everyone who has paid their conference registration fee. Request must be confirmed within 7 days of the receipt of the official email canceling the conference.
1. You may request a full refund of your registration fee.
2. You may request that your registration fee be used to pay for the Virtual Registration fee and the balance of your original payment will be returned to you.
Guests are non-nurses and may be registered at the $275.00 rate. Children's Registration (ages 3-12) $150. Guest and Children's registration includes 1 banquet ticket, 1 brunch ticket, conference bag and name badge.
Type of Registration

Children's Registration - $150.00One-Day Speaker Registration Fee - $150.00Full Speaker Registration - $350.00Non-Nurse Guest Registration - $275.00
Full Name

First NameLast Name
Age
I require additional meal tickets

YesNo
Indicate how many additional tickets are needed per events below.
President's Banquet ($125)
Sunday Brunch ($75)
Method of Payment*

Check, make check out to NBNAPlease invoice for paymentIf you wish to pay by credit card call 301-589-3200 and ask for Dianne Mance
Amount Enclosed or to be Charged*
Type a question
All attendees and their guest must complete the affirm the following:

I agree to follow all State, Local, Hilton Anatole and NBNA health and safety requirements while attending the NBNA conference.
Signature

Clear
Should be Empty:

National Black Nurses Association, Inc.