EXIT TEDxNHS 2018 Speaker nomination form If you know someone who belongs on the TEDxNHS 2018 stage, or if you belong there yourself, we want to hear from you!TEDxNHS 2018 aims to bring together ordinary people who choose to do extraordinary things, and in doing so, become part of something greater than themselves. The event, run voluntarily by people in the NHS, aims to be filled with influential and inspiring speakers.TEDxNHS 2018 will take place on Tuesday 21 August 2018 at the incredible BFI IMAX, London. Please complete this speaker nomination form to let us know who you want on the TEDxNHS 2018 stage! OK Question Title * 1. I am nominating: Myself Someone else - you know personally Someone else - you do not know personally OK Question Title * 2. Which TEDxNHS 2018 topic(s) would the nominated speaker be most suited to? Each talk will fall into one of these three themes. Make sure your nomination falls into one of the below for the best chance of being selected. Tick all that apply. Infectious Ideas: Disruptive innovations that go viral Untold Stories: The everyday extraordinary Evolution: Imperfections, survival and learning to adapt OK Question Title * 3. Please rate how original/ fresh/ novel is the material/ story/ idea that you are nominating for? Unoriginal Neutral Highly Original Unoriginal Neutral Highly Original OK Question Title * 4. Please tell us more about the nominated speaker, this could include: - Their work or experience - Honours and distinctions - Why are you recommending them OK Question Title * 5. Please tell us more about your ideas for this possible TEDxNHS 2018 talk, this could include: - What inspires you about them? - What expertise do they bring? - What ideas do they have? - What might be the title of their talk? OK Question Title * 6. Has the nominated speaker spoken publicly before? Yes No Unsure OK Question Title * 7. Please rate how well you think the nominated speaker could communicate their thinking and develop it into a successful talk: Not very well Unsure Definitely Not very well Unsure Definitely OK Question Title * 8. If possible, please provide links to any articles or web pages about the nominated speaker: OK Question Title * 9. About you: First Name * Surname * Email Address Telephone Occupation/ work experience Twitter Handle (@...) LinkedIn Profile URL OK Question Title * 10. About the Nominee (if not you)Please complete as many as possible First Name * Surname * Email address Telephone Occupation/ work experience Twitter Handle (@...) LinkedIn Profile URL Any further information that may help the team to contact the nominee: OK Question Title * 11. Employment or experience of nominated speaker: Employed in NHS Employed within NHS arms length/partner/affiliated bodies i.e CQC, AHSN Expert by Experience (inc patient) Employed within University/Education provider Student None of the above Other (please specify) OK Data protectionData provided WILL NOT be passed on to any 3rd party company for the use of marketing or any other uses. Data is used solely by the TEDxNHS 2018 team to help in the decision process. Contact information will be used to contact individuals for the purpose relating to TEDxNHS 2018 only. OK Question Title * 12. Can the TEDxNHS 2018 team contact you about the information that you have supplied in this nomination form?If you select No we will be unable to contact you regarding this application. Yes No OK Question Title * 13. Do you want to receive further information from TEDxNHS 2018, including details on future ticket sales and event updates?If you select No we will be unable to contact you regarding any TEDxNHS 2018 news in the future. Yes No OK Thank you for completing this nomination form For latest updates see the TEDxNHS 2018 website and follow us on Twitter -roll on the 21 August! Responses to nominationsTEDxNHS 2018 is run voluntarily by aspirant leaders within the NHS and due to the high number of nominations received we are unfortunately unable to provide individual responses to unsuccessful nominations.If you do need to discuss your nomination further please email: Curation@TEDxNHS. OK COMPLETE