Request a Public Health Speaker Question Title * 1. Scheduler's Contact Information Name Organization or Group Name Email Contact Phone Contact Question Title * 2. Type of presentation Business Community School Government Other Question Title * 3. Date requested Question Title * 4. Time requested Question Title * 5. Length requested 20 minutes or less 30 minutes 1 hour Question Title * 6. Topic(s) requested COVID vaccines/updates Long/post-COVID Delta variant COVID prevention (e.g. infection control in the workplace) COVID + Policy (e.g. city councils, Tribal councils, municipalities) COVID + Children (e.g. schools) Public Health Topics Other (please specify) Question Title * 7. Requested speaker: Health Care Provider Chief Medical Officer Question Title * 8. Type of Program Online (e.g. zoom, radio) In-Person (e.g. events, town halls, community councils) Pre-recorded Other (please specify) Question Title * 9. If online, what platform are you using? Please share the link. Question Title * 10. Expected Number of Participants Less than 10 20-30 50+ 100+ Other Question Title * 11. Is this event local or national? Question Title * 12. Please tell us more about your goals for the speaker so they can best meet the needs of your organization/group. Done