Speaker Request Form

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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.

Looking forward to speaking with you!

-Tiffany Gibson, MSN-ED, RN, NPD-BC, CPN

Email *

Full name *

Name Of Organization *

This is a... *

Non-profit Organization

Social/Professional Organization

School of Nursing

Hospital/Healthcare Organization

Corporate Business

Other:

Speaking Engagement Topic *

Is this speaking engagement *

In Person

Virtual

If in person, where's the location? (City, Stete)

Is there a theme for the training/conference? Is yes, please share

How do you want them to feel at the end of the presentation? Inspired, motivated, educated, etc

*

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

*

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