Speaker Request Form
Hello! I appreciate your request to have me speak at your 2024 event. 

Complete the form below to request to have me speak about any of the following topics at your upcoming event. 
  • Emotional Intelligence in Nursing
  • Nursing Professional Development
  • Implicit Bias and Cultural Humility
  • Diversity, Equity, Inclusion and Belonging
  • Leadership at the Bedside
  • Authentically Aligned Nursing
Looking forward to speaking with you!

-Tiffany Gibson, MSN-ED, RN, NPD-BC, CPN
Email *
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Full name *
Your answer
Name Of Organization *
Your answer
This is a... *
Speaking Engagement Topic *
Is this speaking engagement  *
If in person, where's the location? (City, Stete)
Your answer
Is there a theme for the training/conference? Is yes, please share
Your answer
How do you want them to feel at the end of the presentation? Inspired, motivated, educated, etc

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Your answer
If you can change one thing in the organization, what would it be?

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Your answer
Email *
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I'm interested in learning more about the audience
Audience Size *
Role/title of participants *
Tell me about the demographics (gender, race, ethnicity, etc) of the participants. Majority make up of audience is...
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Your answer
Anything else you'd like to share about your organization or event?
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Email *
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Thank You!
I appreciate your submission and will follow up with your request via email in a few days. Feel free to connect with me at hell@newnurse-academy.com. 
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