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Speaker Request Form

The CDC Speakers Bureau is made up of a group of CDC employees who volunteer their time when work permits, to speak to various groups about public health issues. This group comprises employees of all ranks, grades, and areas of expertise.

Please fill out the form below, so that we may look for a CDC speaker that will meet your needs. You may contact the Speakers Bureau at or 404-639-7796.

Type of organization:
Business   Advocacy   
School Health care   
Local Civic Club
Environmental National
Government State/Regional Affiliate
Faith-based Public Health
Topic of presentation:
Pandemic and Avian Influenza   Infectious Disease
Emergency Preparedness Global Health
Vaccine and Immunization  Occupational Safety and Health
CDC in the 21st Century Chronic Disease Prevention
& Health Promotion
Environmental Health
& Injury Prevention
Event Date:
Next 30 Days Next 90 Days
Next 60 Days Next 120 Days
Audience Size:
Audience and Key Participants:
Healthcare Professionals Senior Management
Elected Officials Faculty
Scientists Business Leaders
Volunteers General Public
Travel Expenses Covered:
Yes No
Name and brief description of host organization:
Host organization web address:

Objective of event/conference:

Date desired for speaker acceptance or declination:
Expected media coverage:
Logistical Information
Event Title:
Event date and time:
Event location (building name):
Address of event location:
Directions to location:
Parking availability:
Length of requested presentation:
Name/title of introducer:
Audiovisual capabilities (Powerpoint ready, etc):
Special notes/instructions:
Host Organization Contact Information
Contact name:
Mailing address:
Email adress:
Daytime phone:
Cellular phone for onsite contact:
Please copy and paste agenda into space below:

Page last modified: November 8, 2007