NBNA Online Speaker Registration

Use the form below to complete Step 1 of your online Speaker Registration. After submitting your information you will be sent to Step 2 for online payment.


1. Speaker Registration

 
NBNA Member
 
First Name
 
Last Name
 
Credentials (required*)
 
Job Title
 
Chapter Affiliate
 
Address
 
City
 
State
 
Zip
 
Home Phone
 
Work Phone
 
Fax
 
Email
 
Date
Pick a date  
 
I will attend

(If you plan to attend the entire conference your discounted Conference registration fee will be $175 which inclues 1 banquet ticket and 1 brunch ticket)
  Guests are non-nurses and may be registered at the $150 rate.
  Guest Names Age
    Age
     
 
I require additional meal tickets. (Make your selection below and pay additional tickets in step 2.)
  President's Banquet & Gala $80 per ticket No. of tickets
Brunch $50 per ticket No. of tickets
Institute of Excellence $75 per ticket No. of tickets

  ACCOMMODATIONS  
 
I do not require accommodations.

I will need a hotel reservation. NBNA will reserve a room for each registered presenter based on the information provided below. NBNA will pay one night (Room & Tax ONLY) for out of town presenters. Changes in arrival and departure dates must be made promptly.

I will make my own reservations, NBNA will pay one night (Room & Tax ONLY)
  If you fail to notify NBNA of cancellation of your accommodations, in writing, within 72 hours of your arrival date you will be billed for the unused reservation
 
Arrival Date
Pick a date  
 
Departure Date
Pick a date  
  Bed Size
 
Indicate special requirements:



 
AIRLINE (Presenters are responsible for air travel)