Speaker Forms

OSNA Annual Convention
February 22nd 2014

Building a Stronger Foundation of Care; Empowering The Future of Nursing

Speakers, please fill out this form and click submit. Additionally, please email Jennifer Rosales and attach a photo, bio, and lecture title.oregonsnalegislative@gmail.com

Email photo & bio

Please Complete the Intent to Speak Form Below

* Indicates required field

Speaker name *

First

Last

Organization: *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Your Name and Title as you would like it to appear on publications *

Focus of Your Experience in Nursing *

I consent to and grant Oregon Student Nurses’ Association (OSNA), and Oregon Nurses; Association (ONA), its assigns, designees, licensees and agents the, PERPETUAL, ROYALTY-FREE, LIABILITY-FREE, NON-EXCLUSIVE, right to record and use my name, biographical information, picture, video, and audio in all media. *

I consent to the media release I do not consent and I understand that I will be required to wear a pink name badge to distinguish my position to media.

Please Indicate: Time Constraints, and Technology Needs: Wi-Fi, Power Outlet(s), Screen/Projector, PowerPoint, ect. *

Submit Intent to Speak

OSNA Annual ConventionFebruary 22nd 2014

Please Complete the Intent to Speak Form Below

OSNA Annual Convention
February 22nd 2014