2. Please fill out the form below to request a speaker from the Office of Emergency Management. Only requests for presentations with an audience of at least 15 will be accommodated.
4. Organization Name*
6. Contact Name*
8. Address*
10. City*
11. State*
12. Zip Code*
14. Primary Phone*
15. Fax
17. Email*
19. Company/School/Organization For Which the Event is Being Planned
    If different from above.
21. Topic*
    Please tell us what you would like our staff member to cover.
23. Type of Event
    Clinic, fundraising dinner, community meeting, etc. Please describe.
27. Presentation Calendar
    View Available Dates
29. Date of Event*
    Date of Event
30. Start & End Time*
    Start & End Time Start Time

    —

    Start & End Time End Time
32. Location of Event*
34. City*
35. State*
36. Zip Code*
38. Country*
40. How long will the staff member need to speak?*
41. What will the speaker be required to do?*
    -- Select One --SpeakKeynotePanelistPanel ModeratorGroup Session LeaderOther
43. If Other, Please Describe
45. Audience Size*
46. Target Audience (adults, children, etc.)*
48. Presentation Materials

    Please check the boxes for materials that will be available at your location.

    1. Laptop computer
    2. Projector
    3. Video software
    4. TV/Monitor
    5. Projector screen
    6. Staff member must bring needed equipment
Leave This Blank:


50. Submit

* indicates a required field