CINXE.COM

Speaker Abstract Submission Form

<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01//EN" "http://www.w3.org/TR/html4/strict.dtd"> <html lang="en-US" class="supernova "><head> <meta http-equiv="Content-Type" content="text/html; charset=utf-8" /> <link rel="alternate" type="application/json+oembed" href="https://nsna.jotform.com/oembed/?format=json&amp;url=https%3A%2F%2Fnsna.jotform.com%2F233384264251959" title="oEmbed Form"> <link rel="alternate" type="text/xml+oembed" href="https://nsna.jotform.com/oembed/?format=xml&amp;url=https%3A%2F%2Fnsna.jotform.com%2F233384264251959" title="oEmbed Form"> <meta name="robots" content="noindex,nofollow"> <meta property="og:title" content="Speaker Abstract Submission Form" > <meta property="og:url" content="https://nsna.jotform.com/233384264251959" > <meta property="og:description" content="Please click the link to complete this form." > <meta name="slack-app-id" content="AHNMASS8M"> <meta property="og:image" content="https://nsna.jotform.com/uploads/carol/form_files/NSNAlogo-whiteRGB.65579da6bd2cf5.97150352.png" /> <link rel="shortcut icon" href="https://nsna.jotform.com/favicon.ico"> <link rel="apple-touch-icon" href="https://nsna.jotform.com/favicon.ico"> <link rel="canonical" href="https://nsna.jotform.com/233384264251959" /> <meta name="viewport" content="width=device-width, initial-scale=1.0, maximum-scale=2.0, user-scalable=1" /> <meta name="HandheldFriendly" content="true" /> <title>Speaker Abstract Submission Form</title> <link href="https://nsna.jotform.com/static/formCss.css?3.3.58817" rel="stylesheet" type="text/css" /> <link type="text/css" rel="stylesheet" href="https://nsna.jotform.com/stylebuilder/static/form-common.css?v=63b8091 "/> <style type="text/css">@media print{*{-webkit-print-color-adjust: exact !important;color-adjust: exact !important;}.form-section{display:inline!important}.form-pagebreak{display:none!important}.form-section-closed{height:auto!important}.page-section{position:initial!important}}</style> <link type="text/css" rel="stylesheet" href="https://nsna.jotform.com/css/styles/nova.css?3.3.58817" /> <link type="text/css" rel="stylesheet" href="https://nsna.jotform.com/themes/CSS/566a91c2977cdfcd478b4567.css?v=3.3.58817&themeRevisionID=59fb4852cf3bfe589c6c6f21"/> <link type="text/css" rel="stylesheet" href="https://nsna.jotform.com/css/styles/payment/payment_feature.css?3.3.58817" /> <style type="text/css"> .form-label-left{ width:150px; } .form-line{ padding-top:12px; padding-bottom:12px; } .form-label-right{ width:150px; } body, html{ margin:0; padding:0; background:#fff; } .form-all{ margin:0px auto; padding-top:0px; width:650px; color:#555 !important; font-family:"Lucida Grande", "Lucida Sans Unicode", "Lucida Sans", Verdana, sans-serif; font-size:14px; } .form-radio-item label, .form-checkbox-item label, .form-grading-label, .form-header{ color: #555; } </style> <style type="text/css" id="form-designer-style"> /* Injected CSS Code */ /*PREFERENCES STYLE*/ .form-all { font-family: Lucida Grande, sans-serif; } .form-line { margin-top: 12px; margin-bottom: 12px; padding-top: 0; padding-bottom: 0; } .form-all { max-width: 650px; width: 100%; } .form-label.form-label-left, .form-label.form-label-right, .form-label.form-label-left.form-label-auto, .form-label.form-label-right.form-label-auto { width: 150px; } .form-all { font-size: 14px } .supernova .form-all, .form-all { background-color: #fff; } .form-all { color: #555; } .form-header-group .form-header { color: #555; } .form-header-group .form-subHeader { color: #555; } .form-label-top, .form-label-left, .form-label-right, .form-html, .form-checkbox-item label, .form-radio-item label, span.FITB .qb-checkbox-label, span.FITB .qb-radiobox-label, span.FITB .form-radio label, span.FITB .form-checkbox label, [data-blotid][data-type=checkbox] [data-labelid], [data-blotid][data-type=radiobox] [data-labelid], span.FITB-inptCont[data-type=checkbox] label, span.FITB-inptCont[data-type=radiobox] label { color: #555; } .form-sub-label { color: #6f6f6f; } .supernova { background-color: undefined; } .supernova body { background: transparent; } .form-textbox, .form-textarea, .form-dropdown, .form-radio-other-input, .form-checkbox-other-input, .form-captcha input, .form-spinner input { background-color: undefined; } .supernova { background-repeat: no-repeat; background-size:cover; background-attachment: fixed; background-position: center top; } .supernova, #stage { background-image: none; } .form-all { background-image: none; } /*PREFERENCES STYLE*//*__INSPECT_SEPERATOR__*/ .form-label.form-label-auto { display: block; float: none; text-align: left; width: 100%; } /* Injected CSS Code */ </style> <link type="text/css" rel="stylesheet" href="https://nsna.jotform.com/css/styles/buttons/form-submit-button-cool_grey_rounded.css?3.3.58817"/> <script>window.enableEventObserver=true</script> <script src="https://nsna.jotform.com/static/prototype.forms.js?v=3.3.58817" type="text/javascript"></script> <script src="https://nsna.jotform.com/static/jotform.forms.js?v=3.3.58817" type="text/javascript"></script> <script src="https://nsna.jotform.com/js/punycode-1.4.1.min.js?v=3.3.58817" type="text/javascript" defer></script> <script src="https://nsna.jotform.com/js/vendor/imageinfo.js?v=3.3.58817" type="text/javascript"></script> <script src="https://nsna.jotform.com/file-uploader/fileuploader.js?v=3.3.58817" type="text/javascript"></script> <script src="https://nsna.jotform.com/s/umd/7fd8914c83a/for-widgets-server.js?v=3.3.58817" type="text/javascript"></script> <script type="text/javascript"> JotForm.newDefaultTheme = false; JotForm.extendsNewTheme = false; JotForm.singleProduct = false; JotForm.newPaymentUIForNewCreatedForms = false; JotForm.texts = {"confirmEmail":"E-mail does not match","pleaseWait":"Please wait...","validateEmail":"You need to validate this e-mail","confirmClearForm":"Are you sure you want to clear the form","lessThan":"Your score should be less than or equal to","incompleteFields":"There are incomplete required fields. Please complete them.","required":"This field is required.","requireOne":"At least one field required.","requireEveryRow":"Every row is required.","requireEveryCell":"Every cell is required.","email":"Enter a valid e-mail address","alphabetic":"This field can only contain letters","numeric":"This field can only contain numeric values","alphanumeric":"This field can only contain letters and numbers.","cyrillic":"This field can only contain cyrillic characters","url":"This field can only contain a valid URL","currency":"This field can only contain currency values.","fillMask":"Field value must fill mask.","uploadExtensions":"You can only upload following files:","noUploadExtensions":"File has no extension file type (e.g. .txt, .png, .jpeg)","uploadFilesize":"File size cannot be bigger than:","uploadFilesizemin":"File size cannot be smaller than:","gradingScoreError":"Score total should only be less than or equal to","inputCarretErrorA":"Input should not be less than the minimum value:","inputCarretErrorB":"Input should not be greater than the maximum value:","maxDigitsError":"The maximum digits allowed is","minCharactersError":"The number of characters should not be less than the minimum value:","maxCharactersError":"The number of characters should not be more than the maximum value:","freeEmailError":"Free email accounts are not allowed","minSelectionsError":"The minimum required number of selections is ","maxSelectionsError":"The maximum number of selections allowed is ","pastDatesDisallowed":"Date must not be in the past.","dateLimited":"This date is unavailable.","dateInvalid":"This date is not valid. The date format is {format}","dateInvalidSeparate":"This date is not valid. Enter a valid {element}.","ageVerificationError":"You must be older than {minAge} years old to submit this form.","multipleFileUploads_typeError":"{file} has invalid extension. Only {extensions} are allowed.","multipleFileUploads_sizeError":"{file} is too large, maximum file size is {sizeLimit}.","multipleFileUploads_minSizeError":"{file} is too small, minimum file size is {minSizeLimit}.","multipleFileUploads_emptyError":"{file} is empty, please select files again without it.","multipleFileUploads_uploadFailed":"File upload failed, please remove it and upload the file again.","multipleFileUploads_onLeave":"The files are being uploaded, if you leave now the upload will be cancelled.","multipleFileUploads_fileLimitError":"Only {fileLimit} file uploads allowed.","dragAndDropFilesHere_infoMessage":"Drag and drop files here","chooseAFile_infoMessage":"Choose a file","maxFileSize_infoMessage":"Max. file size","generalError":"There are errors on the form. Please fix them before continuing.","generalPageError":"There are errors on this page. Please fix them before continuing.","wordLimitError":"Too many words. The limit is","wordMinLimitError":"Too few words. The minimum is","characterLimitError":"Too many Characters. The limit is","characterMinLimitError":"Too few characters. The minimum is","ccInvalidNumber":"Credit Card Number is invalid.","ccInvalidCVC":"CVC number is invalid.","ccInvalidExpireDate":"Expire date is invalid.","ccInvalidExpireMonth":"Expiration month is invalid.","ccInvalidExpireYear":"Expiration year is invalid.","ccMissingDetails":"Please fill up the credit card details.","ccMissingProduct":"Please select at least one product.","ccMissingDonation":"Please enter numeric values for donation amount.","disallowDecimals":"Please enter a whole number.","restrictedDomain":"This domain is not allowed","ccDonationMinLimitError":"Minimum amount is {minAmount} {currency}","requiredLegend":"All fields marked with * are required and must be filled.","geoPermissionTitle":"Permission Denied","geoPermissionDesc":"Check your browser's privacy settings.","geoNotAvailableTitle":"Position Unavailable","geoNotAvailableDesc":"Location provider not available. Please enter the address manually.","geoTimeoutTitle":"Timeout","geoTimeoutDesc":"Please check your internet connection and try again.","selectedTime":"Selected Time","formerSelectedTime":"Former Time","cancelAppointment":"Cancel Appointment","cancelSelection":"Cancel Selection","noSlotsAvailable":"No slots available","slotUnavailable":"{time} on {date} has been selected is unavailable. Please select another slot.","multipleError":"There are {count} errors on this page. Please correct them before moving on.","oneError":"There is {count} error on this page. Please correct it before moving on.","doneMessage":"Well done! All errors are fixed.","invalidTime":"Enter a valid time","doneButton":"Done","reviewSubmitText":"Review and Submit","nextButtonText":"Next","prevButtonText":"Previous","seeErrorsButton":"See Errors","notEnoughStock":"Not enough stock for the current selection","notEnoughStock_remainedItems":"Not enough stock for the current selection ({count} items left)","soldOut":"Sold Out","justSoldOut":"Just Sold Out","selectionSoldOut":"Selection Sold Out","subProductItemsLeft":"({count} items left)","startButtonText":"START","submitButtonText":"Submit","submissionLimit":"Sorry! Only one entry is allowed. <br> Multiple submissions are disabled for this form.","reviewBackText":"Back to Form","seeAllText":"See All","progressMiddleText":"of","fieldError":"field has an error.","error":"Error"}; JotForm.isFormViewTrackingAllowed = true; JotForm.replaceTagTest = true; JotForm.submitError="jumpToFirstError"; JotForm.enterprise = "nsna.jotform.com"; window.addEventListener('error', function(event) { var error = event.error || event; var xhr = new XMLHttpRequest(); xhr.open('POST', "https://nsna.jotform.com/API/formInitCatchLogger/233384264251959", true); xhr.setRequestHeader('Content-type', 'application/json'); xhr.send(JSON.stringify({ data: { stack: error.stack || error.message, agent: navigator && navigator.userAgent, referrer: location && location.href }, title: 'FORM_EXCEPTION' })); }); JotForm.init(function(){ /*INIT-START*/ if (window.JotForm && JotForm.accessible) $('input_6').setAttribute('tabindex',0); if (window.JotForm && JotForm.accessible) $('input_9').setAttribute('tabindex',0); if (window.JotForm && JotForm.accessible) $('input_21').setAttribute('tabindex',0); if (window.JotForm && JotForm.accessible) $('input_19').setAttribute('tabindex',0); JotForm.setCustomHint( 'input_19', 'Please provide a link to a portfolio or website with videos of previous speaking engagements.' ); if (window.JotForm && JotForm.accessible) $('input_5').setAttribute('tabindex',0); if (window.JotForm && JotForm.accessible) $('input_24').setAttribute('tabindex',0); JotForm.setCustomHint( 'input_24', 'Please provide a brief description of the session.' ); if (window.JotForm && JotForm.accessible) $('input_11').setAttribute('tabindex',0); JotForm.setCustomHint( 'input_11', 'Please provide an outline of how the session will be presented.' ); if (window.JotForm && JotForm.accessible) $('input_34').setAttribute('tabindex',0); JotForm.setCustomHint( 'input_34', 'Please provide 2-3 educational outcomes of this session.' ); if (window.JotForm && JotForm.accessible) $('input_45').setAttribute('tabindex',0); JotForm.setCustomHint( 'input_45', 'Please provide any additional information that you feel would be relevant to your submission.' ); setTimeout(function() { JotForm.initMultipleUploads(); }, 2); /*INIT-END*/ }); setTimeout(function() { JotForm.paymentExtrasOnTheFly([null,{"name":"clickTo","qid":"1","text":"Call for Abstracts","type":"control_head"},{"name":"submit","qid":"2","text":"Submit Abstract","type":"control_button"},null,{"name":"topic4","qid":"4","subLabel":"select abstract topic","text":"Abstract Topic","type":"control_dropdown"},{"name":"abstractTitle","qid":"5","text":"Abstract Title","type":"control_textarea"},{"name":"credentials","qid":"6","text":"Credentials","type":"control_textarea"},null,null,{"name":"employer","qid":"9","text":"Employer","type":"control_textarea"},{"name":"email10","qid":"10","text":"E-mail","type":"control_email"},{"name":"abstract11","qid":"11","subLabel":"","text":"Abstract Outline","type":"control_textarea"},{"name":"abstractId12","qid":"12","text":"Abstract ID","type":"control_autoincrement"},{"name":"presenterName","qid":"13","text":"Presenter Name","type":"control_fullname"},null,{"name":"input15","qid":"15","text":"The National Student Nurses' Association (NSNA) is inviting abstract proposals that will contribute to the professional growth of both nursing students and faculty members. All submissions will be thoroughly reviewed, and prospective presenters will be informed if their abstract is selected.\r\nPlease be aware that accepted presenters are required to pay a speaking fee to present at an NSNA meeting. However, presenters may choose to be sponsored by an affiliated organization to cover this cost.\r\nTo submit your abstract, kindly complete the form provided below.\r\n73rd Annual ConventionSeattle, WAApril 9-13, 2025","type":"control_text"},{"name":"divider","qid":"16","text":"Divider","type":"control_divider"},null,null,{"description":"","mde":"No","name":"allPresenters19","qid":"19","subLabel":"","text":"Website","type":"control_textarea","wysiwyg":"Disable"},{"description":"","name":"phoneNumber","qid":"20","text":"Phone Number","type":"control_phone"},{"description":"","mde":"No","name":"jobTitle","qid":"21","subLabel":"","text":"Job Title","type":"control_textarea","wysiwyg":"Disable"},null,{"description":"","name":"yearsOf","qid":"23","text":"Years of Speaking Experience","type":"control_checkbox"},{"description":"","mde":"No","name":"abstractOutline","qid":"24","subLabel":"","text":"Description","type":"control_textarea","wysiwyg":"Disable"},null,null,null,null,{"description":"","name":"bioSubmission","qid":"29","subLabel":"","text":"Upload Bio","type":"control_fileupload"},null,{"description":"","name":"uploadHeadshot","qid":"31","subLabel":"","text":"Upload Headshot","type":"control_fileupload"},null,{"description":"","name":"pleaseUpload","qid":"33","subLabel":"","text":"Please upload files if there are additional sessions you would like to present.","type":"control_fileupload"},{"description":"","mde":"No","name":"pleaseList","qid":"34","subLabel":"","text":"Please list 2-3 educational outcomes of this session","type":"control_textarea","wysiwyg":"Disable"},null,null,null,{"name":"typeA","qid":"38","text":"Terms and Conditions","type":"control_widget"},{"description":"","name":"iWould","qid":"39","text":"I would like to present at the:","type":"control_checkbox"},{"description":"","name":"iWould40","qid":"40","text":"I would like to present a: (Select all that apply)","type":"control_checkbox"},null,null,null,null,{"description":"","mde":"No","name":"pleaseList45","qid":"45","subLabel":"","text":"Additional Information","type":"control_textarea","wysiwyg":"Disable"}]);}, 20); </script> </head> <body> <form class="jotform-form" onsubmit="return typeof testSubmitFunction !== 'undefined' && testSubmitFunction();" action="https://nsna.jotform.com/submit/233384264251959" method="post" enctype="multipart/form-data" name="form_233384264251959" id="233384264251959" accept-charset="utf-8" autocomplete="on"><input type="hidden" name="formID" value="233384264251959" /><input type="hidden" id="JWTContainer" value="" /><input type="hidden" id="cardinalOrderNumber" value="" /><input type="hidden" id="jsExecutionTracker" name="jsExecutionTracker" value="build-date-1732374681661" /><input type="hidden" id="submitSource" name="submitSource" value="unknown" /><input type="hidden" id="buildDate" name="buildDate" value="1732374681661" /><input type="hidden" name="eventObserver" value="1" /> <div id="formCoverLogo" style="margin-bottom:32px" class="form-cover-wrapper form-has-cover form-page-cover-image-align-center"> <div class="form-page-cover-image-wrapper" style="max-width:650px"><img src="https://nsna.jotform.com/uploads/carol/form_files/NSNAlogo-whiteRGB.65579da6bd2cf5.97150352.png" class="form-page-cover-image" width="650" height="99" aria-label="Form Logo" style="aspect-ratio:650/99" /></div> </div> <div role="main" class="form-all"> <ul class="form-section page-section"> <li id="cid_1" class="form-input-wide" data-type="control_head"> <div class="form-header-group header-default"> <div class="header-text httac htvam"> <h2 id="header_1" class="form-header" data-component="header">Call for Abstracts</h2> <div id="subHeader_1" class="form-subHeader">Annual Convention Deadline: January 31, 2025</div> </div> </div> </li> <li class="form-line" data-type="control_text" id="id_15"> <div id="cid_15" class="form-input-wide"> <div id="text_15" class="form-html" data-component="text" tabindex="0"> <p><span style="font-size: 12pt;">The National Student Nurses' Association (NSNA) is inviting abstract proposals that will contribute to the professional growth of both nursing students and faculty members. All submissions will be thoroughly reviewed, and prospective presenters will be informed if their abstract is selected.</span></p> <p><span style="background-color: #ffffff; font-size: 12pt;">Please be aware that accepted presenters are required to pay a speaking fee to present at an NSNA meeting. However, presenters may choose to be sponsored by an affiliated organization to cover this cost.</span></p> <p><span style="font-size: 12pt;">To submit your abstract, kindly complete the form provided below.<br /><br /></span></p> <p style="text-align: center;"><strong><span style="font-size: 12pt;">73rd Annual Convention<br /></span><span style="font-size: 12pt;">Seattle, WA<br />April 9-13, 2025</span></strong></p> </div> </div> </li> <li class="form-line" data-type="control_divider" id="id_16"> <div id="cid_16" class="form-input-wide"> <div class="divider" data-component="divider" style="border-bottom-width:1px;border-bottom-style:solid;border-color:#e6e6e6;height:1px;margin-left:0px;margin-right:0px;margin-top:5px;margin-bottom:5px"></div> </div> </li> <li class="form-line form-line-column form-col-1 jf-required" data-type="control_fullname" id="id_13"><label class="form-label form-label-top" id="label_13" for="first_13" aria-hidden="false"> Presenter Name<span class="form-required">*</span> </label> <div id="cid_13" class="form-input-wide jf-required"> <div data-wrapper-react="true"><span class="form-sub-label-container" style="vertical-align:top" data-input-type="first"><input type="text" id="first_13" name="q13_presenterName[first]" class="form-textbox validate[required]" data-defaultvalue="" autoComplete="section-input_13 given-name" size="10" data-component="first" aria-labelledby="label_13 sublabel_13_first" required="" value="" /><label class="form-sub-label" for="first_13" id="sublabel_13_first" style="min-height:13px">First Name</label></span><span class="form-sub-label-container" style="vertical-align:top" data-input-type="last"><input type="text" id="last_13" name="q13_presenterName[last]" class="form-textbox validate[required]" data-defaultvalue="" autoComplete="section-input_13 family-name" size="15" data-component="last" aria-labelledby="label_13 sublabel_13_last" required="" value="" /><label class="form-sub-label" for="last_13" id="sublabel_13_last" style="min-height:13px">Last Name</label></span></div> </div> </li> <li class="form-line jf-required" data-type="control_email" id="id_10"><label class="form-label form-label-top form-label-auto" id="label_10" for="input_10" aria-hidden="false"> E-mail<span class="form-required">*</span> </label> <div id="cid_10" class="form-input-wide jf-required"> <input type="email" id="input_10" name="q10_email10" class="form-textbox validate[required, Email]" data-defaultvalue="" autoComplete="section-input_10 email" size="30" placeholder="ex: myname@example.com" data-component="email" aria-labelledby="label_10" required="" value="" /> </div> </li> <li class="form-line" data-type="control_phone" id="id_20"><label class="form-label form-label-top form-label-auto" id="label_20" for="input_20_area" aria-hidden="false"> Phone Number </label> <div id="cid_20" class="form-input-wide"> <div data-wrapper-react="true"><span class="form-sub-label-container" style="vertical-align:top" data-input-type="areaCode"><input type="tel" id="input_20_area" name="q20_phoneNumber[area]" class="form-textbox" data-defaultvalue="" autoComplete="section-input_20 tel-area-code" data-component="areaCode" aria-labelledby="label_20 sublabel_20_area" value="" /><span class="phone-separate" aria-hidden="true">聽-</span><label class="form-sub-label" for="input_20_area" id="sublabel_20_area" style="min-height:13px">Area Code</label></span><span class="form-sub-label-container" style="vertical-align:top" data-input-type="phone"><input type="tel" id="input_20_phone" name="q20_phoneNumber[phone]" class="form-textbox" data-defaultvalue="" autoComplete="section-input_20 tel-local" data-component="phone" aria-labelledby="label_20 sublabel_20_phone" value="" /><label class="form-sub-label" for="input_20_phone" id="sublabel_20_phone" style="min-height:13px">Phone Number</label></span></div> </div> </li> <li class="form-line jf-required" data-type="control_textarea" id="id_6"><label class="form-label form-label-top form-label-auto" id="label_6" for="input_6" aria-hidden="false"> Credentials<span class="form-required">*</span> </label> <div id="cid_6" class="form-input-wide jf-required"> <textarea id="input_6" class="form-textarea validate[required]" name="q6_credentials" cols="60" rows="2" data-component="textarea" required="" aria-labelledby="label_6"></textarea> </div> </li> <li class="form-line jf-required" data-type="control_textarea" id="id_9"><label class="form-label form-label-top form-label-auto" id="label_9" for="input_9" aria-hidden="false"> Employer<span class="form-required">*</span> </label> <div id="cid_9" class="form-input-wide jf-required"> <textarea id="input_9" class="form-textarea validate[required]" name="q9_employer" cols="60" rows="3" data-component="textarea" required="" aria-labelledby="label_9"></textarea> </div> </li> <li class="form-line jf-required" data-type="control_textarea" id="id_21"><label class="form-label form-label-top form-label-auto" id="label_21" for="input_21" aria-hidden="false"> Job Title<span class="form-required">*</span> </label> <div id="cid_21" class="form-input-wide jf-required"> <textarea id="input_21" class="form-textarea validate[required]" name="q21_jobTitle" cols="60" rows="3" data-component="textarea" required="" aria-labelledby="label_21"></textarea> </div> </li> <li class="form-line jf-required" data-type="control_checkbox" id="id_23"><label class="form-label form-label-top form-label-auto" id="label_23" aria-hidden="false"> Years of Speaking Experience<span class="form-required">*</span> </label> <div id="cid_23" class="form-input-wide jf-required"> <div class="form-single-column" role="group" aria-labelledby="label_23" data-component="checkbox"><span class="form-checkbox-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_23" type="checkbox" class="form-checkbox validate[required]" id="input_23_0" name="q23_yearsOf[]" required="" value="1-5" /><label id="label_input_23_0" for="input_23_0">1-5</label></span><span class="form-checkbox-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_23" type="checkbox" class="form-checkbox validate[required]" id="input_23_1" name="q23_yearsOf[]" required="" value="5-10" /><label id="label_input_23_1" for="input_23_1">5-10</label></span><span class="form-checkbox-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_23" type="checkbox" class="form-checkbox validate[required]" id="input_23_2" name="q23_yearsOf[]" required="" value="10-15" /><label id="label_input_23_2" for="input_23_2">10-15</label></span><span class="form-checkbox-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_23" type="checkbox" class="form-checkbox validate[required]" id="input_23_3" name="q23_yearsOf[]" required="" value="Over 15" /><label id="label_input_23_3" for="input_23_3">Over 15</label></span></div> </div> </li> <li class="form-line form-line-column form-col-1 jf-required" data-type="control_dropdown" id="id_4"><label class="form-label form-label-top" id="label_4" for="input_4" aria-hidden="false"> Abstract Topic<span class="form-required">*</span> </label> <div id="cid_4" class="form-input-wide jf-required"> <span class="form-sub-label-container" style="vertical-align:top"><select class="form-dropdown validate[required]" id="input_4" name="q4_topic4" style="width:150px" data-component="dropdown" required="" aria-label="Abstract Topic"> <option value="">Please Select</option> <option value="Leadership">Leadership</option> <option value="Mentorship">Mentorship</option> <option value="Health Policy">Health Policy</option> <option value="Governance">Governance</option> <option value="Convention Planning">Convention Planning</option> <option value="Population and Global Health">Population and Global Health</option> <option value="Other">Other</option> </select><label class="form-sub-label" for="input_4" id="sublabel_input_4" style="min-height:13px">select abstract topic</label></span> </div> </li> <li class="form-line jf-required" data-type="control_fileupload" id="id_29"><label class="form-label form-label-top form-label-auto" id="label_29" for="input_29" aria-hidden="false"> Upload Bio<span class="form-required">*</span> </label> <div id="cid_29" class="form-input-wide jf-required"> <div data-wrapper-react="true"> <div data-wrapper-react="true"> <div class="qq-uploader-buttonText-value">Browse Files</div><input type="file" id="input_29" name="q29_bioSubmission[]" multiple="" class="form-upload-multiple validate[required]" data-imagevalidate="yes" data-file-accept="pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zip, mp3, wma, mpg, flv, avi, jpg, jpeg, png, gif" data-file-maxsize="10854" data-file-minsize="0" data-file-limit="" data-component="fileupload" required="" /> </div><span style="display:none" class="cancelText">Cancel</span><span style="display:none" class="ofText">of</span> </div> </div> </li> <li class="form-line jf-required" data-type="control_fileupload" id="id_31"><label class="form-label form-label-top form-label-auto" id="label_31" for="input_31" aria-hidden="false"> Upload Headshot<span class="form-required">*</span> </label> <div id="cid_31" class="form-input-wide jf-required"> <div data-wrapper-react="true"> <div data-wrapper-react="true"> <div class="qq-uploader-buttonText-value">Browse Files</div><input type="file" id="input_31" name="q31_uploadHeadshot[]" multiple="" class="form-upload-multiple validate[required]" data-imagevalidate="yes" data-file-accept="pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zip, mp3, wma, mpg, flv, avi, jpg, jpeg, png, gif" data-file-maxsize="10854" data-file-minsize="0" data-file-limit="" data-component="fileupload" required="" /> </div><span style="display:none" class="cancelText">Cancel</span><span style="display:none" class="ofText">of</span> </div> </div> </li> <li class="form-line" data-type="control_textarea" id="id_19"><label class="form-label form-label-top form-label-auto" id="label_19" for="input_19" aria-hidden="false"> Website </label> <div id="cid_19" class="form-input-wide"> <textarea id="input_19" class="form-textarea" name="q19_allPresenters19" cols="60" rows="3" data-component="textarea" aria-labelledby="label_19"></textarea> </div> </li> <li class="form-line jf-required" data-type="control_textarea" id="id_5"><label class="form-label form-label-top form-label-auto" id="label_5" for="input_5" aria-hidden="false"> Abstract Title<span class="form-required">*</span> </label> <div id="cid_5" class="form-input-wide jf-required"> <textarea id="input_5" class="form-textarea validate[required]" name="q5_abstractTitle" cols="60" rows="3" data-component="textarea" required="" aria-labelledby="label_5"></textarea> </div> </li> <li class="form-line jf-required" data-type="control_textarea" id="id_24"><label class="form-label form-label-top form-label-auto" id="label_24" for="input_24" aria-hidden="false"> Description<span class="form-required">*</span> </label> <div id="cid_24" class="form-input-wide jf-required"> <textarea id="input_24" class="form-textarea validate[required]" name="q24_abstractOutline" cols="60" rows="15" data-component="textarea" required="" aria-labelledby="label_24"></textarea> </div> </li> <li class="form-line jf-required" data-type="control_textarea" id="id_11"><label class="form-label form-label-top form-label-auto" id="label_11" for="input_11" aria-hidden="false"> Abstract Outline<span class="form-required">*</span> </label> <div id="cid_11" class="form-input-wide jf-required"> <textarea id="input_11" class="form-textarea validate[required]" name="q11_abstract11" cols="60" rows="15" data-component="textarea" required="" aria-labelledby="label_11"></textarea> </div> </li> <li class="form-line jf-required" data-type="control_textarea" id="id_34"><label class="form-label form-label-top form-label-auto" id="label_34" for="input_34" aria-hidden="false"> Please list 2-3 educational outcomes of this session<span class="form-required">*</span> </label> <div id="cid_34" class="form-input-wide jf-required"> <textarea id="input_34" class="form-textarea validate[required]" name="q34_pleaseList" cols="60" rows="15" data-component="textarea" required="" aria-labelledby="label_34"></textarea> </div> </li> <li class="form-line" data-type="control_textarea" id="id_45"><label class="form-label form-label-top form-label-auto" id="label_45" for="input_45" aria-hidden="false"> Additional Information </label> <div id="cid_45" class="form-input-wide"> <textarea id="input_45" class="form-textarea" name="q45_pleaseList45" cols="60" rows="15" data-component="textarea" aria-labelledby="label_45"></textarea> </div> </li> <li class="form-line" data-type="control_fileupload" id="id_33"><label class="form-label form-label-top form-label-auto" id="label_33" for="input_33" aria-hidden="false"> Please upload files if there are additional sessions you would like to present. </label> <div id="cid_33" class="form-input-wide"> <div data-wrapper-react="true"> <div data-wrapper-react="true"> <div class="qq-uploader-buttonText-value">Browse Files</div><input type="file" id="input_33" name="q33_pleaseUpload[]" multiple="" class="form-upload-multiple" data-imagevalidate="yes" data-file-accept="pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zip, mp3, wma, mpg, flv, avi, jpg, jpeg, png, gif" data-file-maxsize="10854" data-file-minsize="0" data-file-limit="" data-component="fileupload" /> </div><span style="display:none" class="cancelText">Cancel</span><span style="display:none" class="ofText">of</span> </div> </div> </li> <li class="form-line jf-required" data-type="control_checkbox" id="id_39"><label class="form-label form-label-top form-label-auto" id="label_39" aria-hidden="false"> I would like to present at the:<span class="form-required">*</span> </label> <div id="cid_39" class="form-input-wide jf-required"> <div class="form-single-column" role="group" aria-labelledby="label_39" data-component="checkbox"><span class="form-checkbox-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_39" type="checkbox" class="form-checkbox validate[required]" id="input_39_0" name="q39_iWould[]" required="" value="MidYear Conference" /><label id="label_input_39_0" for="input_39_0">MidYear Conference</label></span><span class="form-checkbox-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_39" type="checkbox" class="form-checkbox validate[required]" id="input_39_1" name="q39_iWould[]" required="" value="Annual Convention" /><label id="label_input_39_1" for="input_39_1">Annual Convention</label></span><span class="form-checkbox-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_39" type="checkbox" class="form-checkbox validate[required]" id="input_39_2" name="q39_iWould[]" required="" value="Both meetings" /><label id="label_input_39_2" for="input_39_2">Both meetings</label></span></div> </div> </li> <li class="form-line jf-required" data-type="control_checkbox" id="id_40"><label class="form-label form-label-top form-label-auto" id="label_40" aria-hidden="false"> I would like to present a: (Select all that apply)<span class="form-required">*</span> </label> <div id="cid_40" class="form-input-wide jf-required"> <div class="form-single-column" role="group" aria-labelledby="label_40" data-component="checkbox"><span class="form-checkbox-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_40" type="checkbox" class="form-checkbox validate[required]" id="input_40_0" name="q40_iWould40[]" required="" value="Student Session" /><label id="label_input_40_0" for="input_40_0">Student Session</label></span><span class="form-checkbox-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_40" type="checkbox" class="form-checkbox validate[required]" id="input_40_1" name="q40_iWould40[]" required="" value="Faculty Session" /><label id="label_input_40_1" for="input_40_1">Faculty Session</label></span><span class="form-checkbox-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_40" type="checkbox" class="form-checkbox validate[required]" id="input_40_2" name="q40_iWould40[]" required="" value="Panel Presentation" /><label id="label_input_40_2" for="input_40_2">Panel Presentation</label></span></div> </div> </li> <li class="form-line jf-required" data-type="control_widget" id="id_38"> <div id="cid_38" class="form-input jf-required"> <div data-widget-name="Terms &amp; Conditions" style="width:100%;text-align:Left;overflow-x:auto" data-component="widget-field"><iframe data-client-id="52948fb29322cd302b00000c" title="Terms &amp; Conditions" frameBorder="0" scrolling="no" allowtransparency="true" allow="geolocation; microphone; camera; autoplay; encrypted-media; fullscreen" data-type="iframe" class="custom-field-frame" id="customFieldFrame_38" src="" style="max-width:580px;border:none;width:100%;height:50px" data-width="580" data-height="50"></iframe> <div class="widget-inputs-wrapper"><input id="input_38" class="form-hidden form-widget widget-required " type="hidden" name="q38_typeA" value="" /><input id="widget_settings_38" class="form-hidden form-widget-settings" type="hidden" data-version="2" value="%5B%7B%22name%22%3A%22termsText%22%2C%22value%22%3A%22By%20checking%20this%20box%2C%20I%20agree%20that%20I%20have%20read%20the%20statement%20at%20the%20beginning%20of%20this%20page%20and%20understand%20that%20accepted%20speakers%20are%20required%20to%20pay%20a%20speaking%20fee%20to%20present%20at%20an%20NSNA%20meeting.%20I%20also%20understand%20that%20if%20I%20choose%20to%20proceed%20with%20presenting%2C%20I%20have%20the%20option%20to%20seek%20sponsorship%20from%20an%20affiliated%20organization%20to%20cover%20this%20cost.%22%7D%2C%7B%22name%22%3A%22termsLink%22%2C%22value%22%3A%22www.example.com%22%7D%2C%7B%22name%22%3A%22theme%22%2C%22value%22%3A%22default%22%7D%2C%7B%22name%22%3A%22acceptedText%22%2C%22value%22%3A%22Accepted%22%7D%5D" /></div> <script type="text/javascript"> setTimeout(function() { var _cFieldFrame = document.getElementById("customFieldFrame_38"); if (_cFieldFrame) { _cFieldFrame.onload = function() { if (typeof widgetFrameLoaded !== 'undefined') { widgetFrameLoaded(38, { "formID": 233384264251959 }, undefined) } }; _cFieldFrame.src = "//app-widgets.jotform.io/termsConditions/?qid=38&isOpenedInPortal=undefined&isOpenedInAgent=undefined&align=Left&ref=" + encodeURIComponent(window.location.protocol + "//" + window.location.host) + '' + '' + '' + '&injectCSS=' + encodeURIComponent(window.location.search.indexOf("ndt=1") > -1); _cFieldFrame.addClassName("custom-field-frame-rendered"); } }, 0); </script> </div> </div> </li> <li class="form-line" data-type="control_button" id="id_2"> <div id="cid_2" class="form-input-wide"> <div data-align="left" class="form-buttons-wrapper form-buttons-left jsTest-button-wrapperField"><button id="input_2" type="submit" class="form-submit-button form-submit-button-cool_grey_rounded submit-button jf-form-buttons jsTest-submitField legacy-submit" data-component="button" data-content="">Submit Abstract</button><span>聽</span><button id="input_reset_2" type="reset" class="form-submit-reset form-submit-button-cool_grey_rounded jf-form-buttons" data-component="button">Clear Form</button><span>聽</span><button id="input_print_2" type="button" class="form-submit-print form-submit-button-cool_grey_rounded jf-form-buttons" data-component="button"><img src="https://nsna.jotform.com/images/printer.png" style="vertical-align:middle" alt="Print" /><span id="span_print_2" class="span_print">Print Form</span></button></div> </div> </li> <li style="display:none">Should be Empty: <input type="text" name="website" value="" type="hidden" /></li> </ul> </div> <script> JotForm.showJotFormPowered = "0"; </script> <script> JotForm.poweredByText = "Powered by Jotform"; </script><input type="hidden" class="simple_spc" id="simple_spc" name="simple_spc" value="233384264251959" /> <script type="text/javascript"> var all_spc = document.querySelectorAll("form[id='233384264251959'] .si" + "mple" + "_spc"); for (var i = 0; i < all_spc.length; i++) { all_spc[i].value = "233384264251959-233384264251959"; } </script><input type="hidden" id="input_12" name="q12_abstractId12" class="form-textbox form-hidden" data-defaultvalue="43" data-component="autoincrement" aria-labelledby="label_12" value="43" /> </form></body> </html><script type="text/javascript">JotForm.isNewSACL=true;</script>