Video Competition Application | NACNS :: National Association of Clinical Nurse Specialists

Name(s) with credentials (when applicable):*
Video Category (choose 1):*
- Team Submission
- Individual Submission
Organization/School (Name):*
Organization/School Address:*
Street Address Address Line 2 City State ZIP Code
Primary Contact Name:*
Primary Contact Address:*
Street Address Address Line 2 City State ZIP Code
Primary Contact Phone:*
Primary Contact Phone Type:*
- cell
- work
- home
Primary Contact Email:*
Primary Contact Email Type:*
- work
- home
Video Title:*
Limit to 20 words or less
Video Overview:*
Brief Summary of the Video – 250 words or less.
Video Link:*
See direction to create shareable link in Video Competition Directions.
Talent Releases:*
Download the Talent Release Form.
Drop files here or
Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 10 MB.
Submission Checklist:
- Video 5 minutes or less in length.
- Video addresses the CNS role (see page 1) for the submission year.
- Does not contain any copyrighted elements without permission to use (e.g., music).
- Signed release/authorization for use and posting of video by CNSI on YouTube.
- Signed releases for talent, and crew or locations (if needed) uploaded.
- Help received credited in video (writing, filming, editing).
- Video link included.
- Application fee paid (see below).
Payment Information
Application Fee
Price:
Billing Address*
Street Address Address Line 2 City State ZIP Code
Credit Card*
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Phone
This field is for validation purposes and should be left unchanged.

Payment Information