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Speaker Request

Portrait of CDC Director Thomas R. Frieden, MD, MPHDirector Speaker Request Form

To request CDC Director Tom Frieden′s participation (attending or speaking) in an event or meeting, please complete this form. While some details may not be immediately available, we appreciate your making every effort to submit this form at least six weeks before your event. A member of the CDC Director′s Office will contact you as soon as possible to let you know the CDC Director's availability.

Please note that if the CDC Director is able to attend your event you may be asked to provide a briefing with more detailed information about the event and participants.

Note: Please review the CDC Speakers Bureau Privacy Policy to understand how we use the information gathered to completed speakers requests. If you have any questions or concerns, please contact

Please complete the entire form - all fields are required.

Event Overview

Event Title:
Event Host (department/division/school):
Event Location:
Date of Event (must be 30 days out)

Director's participation requested start time: AM PM
Director's participation requested end time: AM PM

Contact Person:
Office Number:

Cell Number:
Contact Email:
Please give a brief description of organization:

Event Details

What is the purpose of this event? What are the desired outcomes?

Proposed role of Director Speaker Attendee Video Taped Remarks

In the event that the director is unavailable, would you still be interested in a CDC speaker? Yes No

Are remarks or a presentation requested? If so, please indicate the topic, the length
of remarks/presentation and the general type of remarks
(ex. Welcome, introduction of speaker(s), panelist, class lecture, keynote):

Audience and Key Participants

If other, please describe in the notes section

Expected Media Coverage: Yes No

Will this event be videotaped? Yes No

PPT Available: Yes No
Teleprompter Available: Yes No

Please identify any other speakers from CDC requested for this event

Please copy and paste info into space below:
(input limit 3700 characters)

Special Notes

Please use this section to include any additional details, such as the names of scheduled
VIPs that will be attending, that would assist in processing your request.
(input limit 3700 characters)
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  • Page last updated: June 25, 2013
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