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Each speaker should complete the entire survey below. If you have questions regarding any item, please contact speakers@amsn.org for additional clarification.

We look forward to your presentation at the 2025 AMSN Convention!

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* 1. First Name

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* 2. Last Name

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* 3. Credentials

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* 4. Email Address

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* 5. Session Title

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* 6. Session Description: Please provide a three to four (3- 4) sentence description of your session. This will be used in the registration brochure, website, and mobile app.

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* 7. Speaker Introduction: Please provide a three to four (3-4) sentence speaker introduction.

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* 8. Social Media/Promotion: If you are willing, please share links to your Facebook, LinkedIn, and/or Instagram profiles to allow AMSN Marketing to tag you in posts that are specifically promoting your session.

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* 9. Headshot:

Please provide us with an updated headshot. By choosing to do so, you agree that AMSN may use this in marketing materials for the 2025 Convention and as part of speaker profiles in the Convention Mobile App or in marketing materials.

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* 10. Accessibility Access or Accommodations: Presenters will typically need to stand for up to 60 minutes behind a podium to present and may need to walk up and down a short set of stairs to access the stage.

Do you have any access needs or accommodations that you would like us to know about?

(If yes, a member of the AMSN Education Staff team will contact you privately to discuss.)

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* 11. Release of Handouts:

AMSN offers registrants copies of slides as handouts as a supplement to verbal presentations and needs your permission to do so.

I hereby grant my permission for AMSN to upload and distribute my handout material to those registered for the convention and also to those who may request handout material at a later date. I understand that in signing this release, it in no way prohibits me from using my material in any manner that I so desire. If the handouts include copyrighted materials, permission has been granted to me and is included.

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* 12. Release of Email Address:

Occasionally registrants request contact information for follow-up communication with the speaker.

I hereby give my permission to release my email address to participants requesting it.

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* 13. Release for Presentation Inclusion in Online Library:

I understand that AMSN will include my presentation and materials within the AMSN Online Library as a learning tool for registered attendees at the convention and subscribers to the Online Library. Both the audio recording AND the PowerPoint presentation that I use onsite will be captured so that Online Library users can view the session as it was presented.

I understand that I am not prohibited from using my own materials in any manner I so desire. I also understand that the PowerPoint presentation I provide will be available to download as a PDF only; therefore, it cannot be manipulated. AMSN may advertise the availability of my presentation materials for sale to any and all interested parties. I waive any claim for liability on the part of AMSN and agree that no claim for compensation in connection with these recordings is due, now or in the future.

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* 14. Release for Session Streaming:

I understand that AMSN may broadcast my presentation via live media streaming. I understand that this media streaming will include broadcasting of the audio, PowerPoint slides, and live images of me as a speaker. This authorization does not prohibit me from using my own materials in any manner I so desire.

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* 15. Release for Virtual Presentation:

If it becomes necessary for AMSN to hold its Annual Convention in a virtual format, I am willing to present my session virtually via a live media stream virtual broadcast, or pre-recorded on-demand format. I understand the utilization of a live or on-demand virtual format for my session will include broadcasting the audio, PowerPoint slides, and live images of me as a speaker. This authorization does not prohibit me from using my own materials in any manner I so desire.

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