NSNA Field Visit Request Form Includes Virtual Meeting Request

Full name of State association*

State associations may invite an NSNA Board Member to bring greetings at their Annual Convention. Requests for live field visits must be submitted at least 60 days prior to start of the state convention. Requests for video greetings at virtual meetings is 30 days in advance of the event.

Requests are reviewed by the NSNA Executive Committee and decisions are made based on availability of board member, cost and, location if live event, and any other considerations indicated in your request as well as the feasibility of sending a representative.

Note that NSNA Board Members are encouraged to attend their own state conventions. If you have an NSNA Board Member in your state and wish that person to represent NSNA at your meeting, please follow the same procedure by completing this form at least 60 days in advance of your live meeting and 30 days in advance for video taped greetings. Note that NSNA anticipates that if a state association has a member serving on the NSNA Board, that individual may be invited by the state association to be the official NSNA representative at the convention.

Thank you.

Primary Contact Person*

First NameLast Name

Title of Primary Contact Person*

Phone Number*

Area CodePhone Number

E-mail*

Alternate Contact Person*

First NameLast Name

Title of Alternate Contact Person*

Phone Number*

Area CodePhone Number

E-mail*

Name of facility where live convention will take place (i.e. Hotel name)

Address of live Convention location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Start date for your convention*

MonthDayYear

End Date for your convention*

MonthDayYear

Date NSNA representative to bring greetings*

MonthDayYear

Time NSNA representative to bring greetings*

:HourMinutesAM/PM Option

In addition to bringing greetings, is there any other activity you would like the NSNA representative to participate in? Include date and time.

The following expenses may be involved in bringing an NSNA Board Member to your state convention. Please indicate which expenses the state is able to pay for. The inability to cover any expenses will not disqualify your state from receiving a visit. If a hotel room is provided, we ask that a single room be provided; and that the state association make the hotel reservation and send the hotel confirmation number directly to the NSNA Board Member.

Meals that state will provide*

Transportation that state will provide*

Hotel Room (single room required) that state will provide*

Registration for State Convention COMP or pay separately:*

CompPay SeparatelyIf pay separately, please provide registration linkOther

What is the closest airport to your convention location?

Ground Transportation you will provide*

NonePick up from airport/train stationprovide taxi fare/shuttle/car rental/parkingN/A

Comments

NSNA Field Visit REQUEST Form