Chapter Speaker Request Form (AACN President and President-Elect)


Please Note:  The AACN president, president-elect, and other board members are not available during NTI, and have very limited availability in April and November, due to the AACN Board Meetings.  Please refer to the dates listed below.
11/09/13 - 11/13/13   Fall Board Meeting
04/12/14 - 04/15/14   Spring Board Meeting
05/14/14 - 05/23/14   NTI

 


Requester Information:

Requested Speaker: *
Requested Topic (Include description and time frame): *
Chapter/Organization: *
Contact Person: *
Address: *
City: *
State: *
Zip: *
Phone : *
999-999-9999
Email: *

Event Information:

Event Title: *
Event Location: *
Requested Dates: *
Please include times for the presentation and any other activities (i.e. town hall meetings, dinners, etc.): *

  • The Honorarium is a minimum of $500.00 for the Keynote speech ($250.00 minimum per additional breakout session, including fireside chat).
  • Please prepare the Honorarium check, in advance, to present to the speaker on the day of the event.
  • The speaker will provide an Honorarium Transfer Form, with a copy for the chapter and will submit the form and the payment to AACN.
  • Please make all checks payable to AACN.
  • All travel expenses for the speaker will be paid by the chapter/organization (hotel, ground transportation and meals) and will be billed for, by AACN, after the event.
    • Airline reservations will be made by the National office and the chapter will be billed for the cost of the airline ticket. Please note: If you are requesting Teri Kiss as your speaker, her airline expense is generally more than $1000, because she lives in Alaska.
    • Hotel reservations are to be made and pre-paid by the chapter.
  • All requests need to be made a minimum of 45 days in advance and all payments need to be submitted 30 days from invoice date. 
  • Upon confirmation, please contact Melissa Doane, for necessary materials required for Continuing Nursing Education Credit.
  • If you have any questions, please contact Melissa Doane at (800) 394-5995, ext. 215 or by email at Melissa.Doane@aacn.org.

Your Name: *
Your Email: *

 

**Please print this page before you submit it online. This will enable you to keep the form information, listed above, for your records**

 

 

 

revised 8/13

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