ACT Advocate Speaker Request Form

If you would like a registered ACT Advocate (ACT-Alliance for Children in Trafficking) to speak at your event, please complete the below information. Please note, that ACT Advocates may need at least a month's notice before an event. NAPNAP Partners for Vulnerable Youth, which is the organizer for ACT, will follow-up with you on your request within 10 business days. For more urgent requests and other questions, please contact NAPNAP Partners at info@napnappartners.org or 917-746-8305.

First Name *

Last Name *

Contact Email Address *

Contact Phone Number *

Organization Name *

Location of presentation *

Preferred date of presentation * +

Preferred time for the presentation (please include time zone) *

What is your second choice for the presentation date? * +

What type of people will be in attendance at the training? (e.g., nurse practitioners, nurses, doctors, physician assistants) *

Approximately how many people do you expect to attend? *

Are you able to fund the ACT Advocate for modest expenses such as mileage, copying handouts, etc.? Reimbursement of expenses by you is optional. You will directly reimburse the ACT Advocate. *

Yes

Maybe

Any further comments about your presentation request?

In addition to potentially reimbursing expenses, NAPNAP Partners would be grateful for an optional donation directly to NAPNAP Partners, www.NapnapPartners.org. Your donation goes to support our grassroots ACT Advocates and other programs. Donate by going to napnappartners.org and clicking on the green button.

NAPNAP Partners for Vulnerable Youth is a 501(c)(3) organization dedicated to improving the physical and mental health and well-being of vulnerable infants, children, adolescents and young adults. We were founded by the National Association of Pediatric Nurse Practitioners (NAPNAP), a not-for-profit professional society established in 1973. NAPNAP has 50 chapters and 19 special interest groups, which support the massive reach and capacity of NAPNAP Partners. There are 18 founding partners of NAPNAP Partners. Its affiliated NAPNAP Foundation is dedicated to pediatric nurse practitioner research and scholarship, and ready to support this challenge. EIN 82-2709037