Under Florida law, email addresses are public records. If you do not want your email address released in response to a public records request, do not send electronic mail to this entity. Instead contact these offices by phone or in writing.

This field is for validation purposes and should be left unchanged.
Requester Name(Required)
Event Coordinator Name(Required)
Type of Request(Required)
MM slash DD slash YYYY
Time of Event(Required)
:
Organization Type(Required)
Event Address Type(Required)
Event Address(Required)
PowerPoint required?(Required)
Media in attendance?(Required)
Will audience be receiving CME credit?(Required)