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Speaker Request

While some details may not be immediately available, we appreciate you making every effort to submit this form at least six weeks before your event. Requests of extremely short notice (within 10 days of the event) may not be processed since it will not allow for adequate staffing coordination.

Event Overview

Event Details

In the event that the Director is unable to attend, would you still be interested in a CDC speaker?
In the event that the Director is unable to attend in-person, would joining by video teleconference (VTC) be an option?
In the event that the Director is unable to attend in-person or by VTC, would a pre-recorded message be an option?
(Please be specific.)
Expected Media Coverage:
Will this event be videotaped?
PPT Available:
What is your desired presentation format?
Form Validation
  • Page last reviewed: August 31, 2015
  • Page last updated: August 31, 2015
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