Presentation
Information
Type of Organization
Select:
Primary
College
Professional
Other
Faith-Based
Non-Profit
Civic Club
Other
Local
State
Federal
Other
Administration
Public Health
Physicians/Nurses
Other
Financial
Healthcare
Legal
Service
Other
If Type of Organization "Other", please list:
Topic of Presentation
Select:
Bio-terrorism Emergencies
Chemical Emgergencies
Mass Casualties
Natural Disasters
Radiation Emergencies
Recent
Outbreaks and Incidents
Other
Vaccines and Immunizations
HIV-AIDS
Birth
Defects and Developmental Disabilities
Diabetes
TB
Obesity
Other
Pan Flu
Diseases
Disaster Relief Workers
Healthcare
Professionals Traveling Abroad
Other
Climate Change
Water Quality
Air Quality
Extreme
Weather Conditions
Other
Hazards
Illnesses/Injuries/Health
Disorders
Safety and Prevention
Work Place Occupations
Other
CDC in the 21st Century
Public Health Policy
Law
Risk Communications
CDC in the Community
Other
If Topic of Presentation "Other", please list:
Audience Size:
10-50
51-100
101-150
151-200
251-1000
1000+
Audience and Key Participants
Select:
Professional Studies
Graduate Students
Undergraduate Students
High School/Elementary
Other
Local
State
Federal
Other
Senior Management
Middle Management
Employees
Other
Faculty
Teachers
Other
If Audience and Key Participants "Other", please
list:
Travel Expenses Covered:
Yes
No
Type:
Lodging
Airfare
Mileage
Meals
Host Organization Contact Information
Name and Brief Description of Host Organization:
(input limit 800 characters)
Host Organization Web Address:
(input limit 300 characters)
Host Contact Name:
Host Contact Street Address 1:
Host Contact Street Address 2:
Host Contact City, State/Territory, Zip/Postal Code:
State/Territory:
Select:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
US Virgin Islands
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip:
Host Contact Country:
United States
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua And Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia And Herzegovina
Botswana
Bouvet Island
Brazil
British Indian
Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, Democratic
Republic Of The
Cook Islands
Costa Rica
Cote D'ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
(Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island
And Mcdonald Islands
Holy See (Vatican
City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic
Of
Iraq
Ireland
Isle Of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea,
Democratic People's Republic Of
Korea, Republic Of
Kuwait
Kyrgyzstan
Lao People's
Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia,
Former Yugoslav Republic Of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated
States Of
Moldova, Republic Of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory,
Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts And Nevis
Saint Lucia
Saint Martin
Saint Pierre And Miquelon
Saint Vincent And
Grenadines
Samoa
San Marino
Sao Tome And Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South
Georgia And South Sandwich Islands
Spain
Sri Lanka
Sudan
Suriname
Svalbard And Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province Of
China
Tajikistan
Tanzania, United
Republic Of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad And Tobago
Tunisia
Turkey
Turkmenistan
Turks And Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis And Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Email Address:
Daytime Phone:
Cell Phone for Onsite Contact:
Expected Media Coverage:
National Media Outlets
None
Logistical Information Event Title:
(input limit 150 characters)