Request for Use of NLN Mediallion File for Marketing

Please complete ALL fields.

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* 1. First Name

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* 2. Last Name

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* 3. Credentials

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* 4. Email

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* 5. Expert Clinician Number

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* 6. Is this your first time requesting the file?

Yes

If no, please enter the number of times prior to this that you have requested use of the file.

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* 7. Use of the NLN EC medallion logo requires agreement to the following:

The medallion file will be used professionally and only related to marketing directly associated to the NLN Expert Clinician’s name and no other clinician.

Each NLN EC clinician needs to submit their individual requests.

If found to be using the file inappropriately, the privileges to use the logo will be revoked, and the clinician will no longer be allowed to use the logo in any personal or commercial capacity.

The clinician may only use the logo while the NLN EC status is current and in good-standing. If the NLN EC designation receives an inactive status, the clinician can no longer use the logo until all necessary requirements have been fulfilled. The clinician will then have to complete a new application to use the medallion logo file.

Agree

Thank you for completing this request. Please note that you should receive the requested materials within 7-10 business days, unless additional information is required.