CSTLTS Director: Speaking Request

Experiencing Challenges Submitting Your Speakers Request?

Please let us know by emailing KSives@cdc.gov for assistance.

To request the CSTLTS Director as a speaker at an event or meeting, please complete and submit this form.

Requestor email:*

Requesting organization:*

Requestor name:*

Requestor phone number:*

Event POC name:*

Event POC email:*

Event POC phone number:*

Event name:*

Event date(s):*

Event summary:*

(e.g., short description, link to conference or event website)

Type of talk:*

(e.g., keynote, plenary, panel, welcome)

Date of talk:*

Time of talk:*

(include time zone)

Length of talk:*

(e.g., 20 minutes, 30 minutes)

Presentation or slides needed for talk?:*

Date presentation or slides needed in advance to POC:*

How will this talk be delivered?*

(in-person, virtual or recorded)

Location of talk:*

If not applicable, type N/A

Zoom or Teams link for Dr. Montero:*

If not applicable, type N/A

Who will introduce Dr. Montero at this talk?*

Target audience for this talk?*

Size of audience for this talk?:*

(internal meeting/5 people; in-person, virtual or recorded)

Topic(s) for Dr. Montero to cover in remarks or presentation/slides and desired outcome for this talk:*

How will you promote this talk?*

Will media be invited to this talk?*

* Required field

If an event agenda is available, please email a copy to KSives@cdc.gov after you submit this form.

Page last reviewed: July 27, 2022