Convention Speaker Form

Submit your completed Speaker Form no later than April 1, 2026.

NSLHA welcomes suggestions for speakers + topics as well.

2026 Convention Speaker Form

Step 1 of 2

Contact Name (person completing form)

First Last

Phone

Speakers

Name	Email	Initials / Credentials	Phone	Company	Bio (describe your qualifications, degree(s) and where earned, and your professional experience):	Bio (describe your qualifications, degree(s) and where earned, and your professional experience):	Honorarium	Speaker Honorarium amount requested	Present In-Person or Virtual	Travel Expense Reimbursement	Travel Expense needs: please specify	Please provide a financial disclosure statement. (Example: John Doe is employed by ABC Corporation).	Please provide a non-financial disclosure statement. (Example: John Doe has no nonfinancial relationships to disclose).	Actions

There are no Speakers.

All Information required for each Speaker that will be Presenting.

Co-Authors: Not Presenting(Required)

Yes

Are there any Co-Authors that you would like to recognize? These people will NOT be presenting.

Co-Authors Not Presenting

First Name

Last Name

Initials or Credentials

Bio