National League for Nursing Speaker / Consultant Inquiry Form

Please provide the following information to inquire about booking a NLN Speaker or Consultant.
You should expect a response within three business days from the email address CSB@NLN.org.

Contact Information

Name: *This question is required.

Email Address *This question is required. This question requires a valid email address.

Confirm E-mail Address
Note: Email addresses must exactly match *This question is required. This question requires a valid email address.

Phone Number *This question is required.

Your Organization / School / Program / Company [if applicable] *This question is required.

Event Details

Event Type (select all that apply): *This question is required.

Panel Moderator
Facilitate Q&A Session
Breakout Session
Webinar
Conference
Speaking Event
Seeking a Consultant
Other - Write In Please enter an 'other' value for this selection. * This question is required.

In Person or Virtual? *This question is required.

Will this speaking event require a Q&A session? *This question is required.

Event Location & Description (e.g., length of time, purpose, number of attendees) *This question is required.

Description of Consulting Service Requested (e.g., Competency-based education implementation, Approaching accreditation or re-accreditation process, Quality improvement initiatives, other [please list below]).
*This question is required.

Please list the topic or theme you are seeking a speaker or consultant for (e.g., campus well-being, commencement ceremony, competency-based education, leadership, power, staff development, student incivility & conflict management, other [please list below]) *This question is required.

Name of Desired Speaker(s) or Consultant(s) *This question is required.

Select the Date of the Event *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

Additional Comments/Requirements
(For example, if you have a conference with multiple dates, you can enter them here.)