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AANP National Conference – Keynote Speaker Submission Form
AANP National Conference – Keynote Speaker Submission Form
Leave this field blank
Section 1
First Name
Last Name
Professional Title
Organization / Affiliation Name
Email Address
Phone Number
Website or Professional Profile
Section 2: Speaker Background
Brief Professional Bio
(150 words or less)
Link to Speaker Reel
Areas of Expertise
Check all that apply.
Clinical Practice
Health Policy
Leadership
Education
Research
Workforce Development
Rural Health
Technology / Innovation
Other:
Other
Years of Speaking Experience
Select one.
0–2
3–5
6–10
10+
Section 3: Proposed Keynote Topic
Proposed Keynote Title
Keynote Description
(150 words or less)
How is this topic relevant to nurse practitioners?
(150 words or less)
Section 4: Logistics & Requirements
Speaking Fee Range
Select one.
<$5,000
$5,000–$10,000
$10,000-$15,000
$15,000-$25,000
$25,000-$35,000
$35,000+
Travel Requirements
Submit