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
Select One
Yes
No
First Name
Last Name
Credentials
(required*)
Title/Agency
Address
City
State
Select
AL
AK
AR
AZ
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NV
NE
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip
Home Phone
Work Phone
Fax
Email
Date
I will attend
Select One
One Day Only
Entire Conference
(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
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)
Select One
I do not require accommodations
I will need a hotel
I will make my own reservations
The Mandalay Bay Requires a deposit of one nights Room & Tax at the time you make your reservation. Refunds will only be made if you cancel your reservation 72 hours before your scheduled arrival
Arrival Date
Departure Date
Bed Size
Select One
Single-King
Double
Quad
Room
Select One
Smoking
Non-Smoking
AIRLINE (Presenters are responsible for air travel)
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National Black Nurses Association