Conference Speaker Application form

Primary Speaker's Name - Reminder ONLY Primary Speaker Receives Free attendance to Conference, all other speakers MUST register and pay for conference.

First NameLast Name

Credentials

RN, LPN, NP, DNP...

Position/Title

Facility Name as Applicable. If not applicable place a N/A in the box.

City

State

Phone Number

Format: (000) 000-0000.

Personal E-mail

Confirmation Emailexample@example.com **Please note that some healthcare facilities have security protocols that prevent work emails from receiving messages from external sources.

The title of your session is the first impression for Conference Attendees. Use a concise, but inclusive, title which clearly conveys what you will be presenting and draws attendees' attention to your topic.

Title of Your Session:

Abstract: Your session abstract will tell Conference Attendees why they should attend your session. To be effective and create interest, it should provide a brief, clear, and concise reflection of your presentation’s content. The abstract should only be one paragraph of between 150 to 250 words in length.

0/250

Outline Your Key Elements. List 4 to 5 primary or key elements of your topic that you will be discussing.

0/250

Importance to Nursing.

0/250

Bio for Speaker # 1

Speakers Name # 2

Bio for Speaker # 2

Speakers Name # 3

Bio for Speaker # 3

resume/CV

PDF, DOC, or DOCX

I agree to submit my presentation prior to the Conference

I understand that my presentation will be available on the Tucson Nurses Week Foundation website for members to download

I have verfied that all information provided is accurate. and complete