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Speaker Request

While some details may not be immediately available, we appreciate you making every effort to submit this form at least 60 days before your event. Requests of extremely short notice (within 10 days of the event) may not be processed since it will not allow for adequate staffing coordination.

Event Overview

Event Details

If the Director is unable to attend, would you be interested in hosting another CDC speaker?
If the Director is unable to attend in person, would joining by video teleconference be an option?
If the Director is unable to attend in person or by video teleconference, would a pre-recorded message be an option?

Presentation Details

If panel, please provide a list of other invited and/or confirmed panelists.
PowerPoint Requested:
Will there be a Q&A:
Expected Media Coverage:
Will this event be videotaped?
Form Validation

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  • Page last reviewed: August 31, 2015
  • Page last updated: September 29, 2017
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