skip to content

It's a New Day in Public Health.

The Florida Department of Health works to protect, promote & improve the health of all people in Florida through integrated state, county, & community efforts.

skip to content
 

Meeting and Public Speaking Request Form

Contact the Florida Department of Health

Please only submit request that will be occurring within the next 6 months.

Please note, under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing.

Required fields are marked with an asterisk (*)

First Name: *


Last Name: *

Job Title: *


Email: *


Phone: *


Type of request: *


Date of event: *     (mm-dd-yyyy)


Time of event: *     (24h format)

Organization Name: *


Organization Type: *

Location/Event Address:


City:


State:


Zip/Postal Code:


Preferred Length/Duration in minutes:


Details of Request:
(Including name of event, preferred subject matter, link to website or agenda, etc. Please be as specific as possible.)


Audience type: *     (MDs, lawyers, general public)


Attendees of note:  (name & title)


Any additional Materials needed? *     (if Yes, details)


Media in attendance? *     (Yes or No)


Any additional event obligations? *     (if Yes, details)