NBNA Presidential Appearance Request (Other)

NBNA Presidential Appearance Request

Fill out this form to make a formal request to have the NBNA President have a presence at your upcoming event.
Title of Event:
Date of Event:*
Day, Month, Date, Year (ex: Tuesday, October 9, 2023)
Time of Event:*
Start to Finish (ex: 6pm - 8pm)
Type of Event:*
Or Add Event Type:
Type of Appearance Requested (In-Person):

Keynote (Speech) AddressOpening GreetingsClosing GreetingsProgram ModeratorMaster of Ceremony
Type of Appearance Requested (Other):

Video/Zoom-TapedLetter of acknowledgement for program book

What are you willing to cover? (check all that apply):

	Yes	No
Honorarium (If Yes, Fill in Amount)
Roundtrip Transportation (Airfare, Train Fare, etc., please list all that apply)
Hotel Accommodations