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Home » Get Involved » Parkland in your Community » Virtual Parkland Speakers Bureau » Application to request a speaker
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Home > Get Involved > Parkland in your Community > Virtual Parkland Speakers Bureau > Application to request a speaker

Application to request a speaker

Virtual Parkland Speakers Bureau provides a variety of healthcare professional speakers who are committed to building awareness through many educational programming efforts. Our professionals help educate, inspire, and motivate individuals throughout the community. This is a free service that covers diverse topics and can be customized to fit the needs of churches, schools, clubs and other community organizations.

To schedule a virtual speaker or request more information, please fill out an application to request a speaker.

Note: Our speakers are well received in the community, therefore, please allow at least a four-six week notice for requests. Participation in your event is based on staff availability.

* indicates required field

Organization & Contact

* Contact Name
* Company/Organization
* Street Address
* City/Town
* State
* ZIP
* County
* Contact Email Address
* Confirm Email Address
* Phone Number
 
* How did you find out about our Speakers Bureau services?
(Please select all that apply)








If you selected 'Other' above, please specify:

Event Details

* Date of Event
 Time of Event
If the event details are being considered upon the Speaker's availability, you may leave this option blank to indicate that the date/time are "flexible.
* How much time will the speaker have to present?
Does presentation time include Q&A?:
Is a photo of the speaker needed? (If yes, please specify due date):
Is a biography of the speaker needed? (If yes, please specify due date):

Speaking Engagement: Topic and Format
* Subject/Topic
(e.g. "Eating right, doesn't mean you eat what's left") = Nutrition Education
* Is there an agenda/schedule for the event?
(If yes, please provide a copy to parklandcommunityrelations@phhs.org)
* What is the format of the event?
(e.g. Town Hall, Roundtable, etc.)

Audience Details

* How many people are expected to attend?
If you selected 'Other' above, please specify:
Does your audience have a language preference?
NOTE: most presentations are conducted in English. Some foreign language requests can be met - based on request and speaker availability.



If you selected 'Other' above, please specify:
* Audience type?
 
(e.g. teachers, nurses, faith leaders)

Other Speaker(s)

* Are there other speakers at this event?



Please specify the names and topics of the other speaker(s) who will be presenting
Speaker Name/Topic
Speaker Name/Topic
Speaker Name/Topic

 

Virtual Support

What online platform will be used? (WebEx, Zoom, Facebook Live, etc.):

Marketing

How is the event being promoted? (social media, radio, etc.):

Additional Information

* Would you like to receive news and updates about Parkland by email?


Is there anything else we need to know about your group/event?
If YES, please explain.
Please enter the letters you see below

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