To request a speaker, please check all topics listed below that apply. Or, if you do not see your topic listed below, check "other" and write a topic you wish to be covered.

• Your Name *

  Title

  First

  Last

  Suffix

• Your Email *

   

• Your Phone Number *
  -

  (###)

  -

  ###

  ####

• Date of Event *
  
• Address of Event *

  Street Address

  Address Line 2

  City

  State / Province / Region

  Postal / Zip Code

• Event Times *
  -

  12:00 - 4:00

• Topics You Wish to Cover
  Burn Awareness
  Cardiac Catheterization
  Cardiovascular Topics
  Children and Health Issues
  Diabetes
  Effects of Sun on the Skin / Skin Care
  General Cancer Related Topics
  Heart Dysrythmias
  HIV/Aids Education
  Medical Mission Trip to Iraq
  Nebraska Regional Poison Center and Common Household Poisonings
  Nursing Career Opportunities
  Nursing as a Profession
  Patient Safety
  Pediatric and Perinatal Bereavement
  Pediatric Growth and Development
  Premature Babies
  Role of the Research Nurse
  Sexually Transmitted Diseases (STD's)
  Trauma Education for Teens - Drinking & Driving/Car Accidents
  Teen Pregnancy
  Wound Care/Pressure Ulcer Prevention
  Other
• Attendees *

  How many are attending your event

• Notes

  * Any equipment needed for the presentation (audio/visual, projector, screen, microphone, computer set-up) must be provided by your organization. Handouts will be provided by our speaker if necessary.

  * At least 3 weeks notice must be given prior to needed speaking engagement date.

  * Travel expenses (mileage, lodging, meals) to be negotiated with the requesting organization.

• Additional Comments
• 
  * - Required Fields