Request a Presentation

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 20 will be accommodated.

Organization Name*
Contact Name*
Mailing Address*
Primary Phone (For example: 999-999-9999)*	Fax (For example: 999-999-9999)
Email Address
Company/School/Organization for which the event is being planned (if different from above)
Topic (Please tell us what you would like our staff member to cover.)*
Type of Event (Clinic, Fundraising Dinner, Community Meeting, etc.) Please describe.
Date of Event*
Start Time*	End Time*

Location of Event*
How long will the staff member need to speak?*	What will the speaker be required to do?*

If other, please describe
Audience Size*	Target Audience*

Presentation Materials(Please check the boxes for materials that will be available at your location.) Laptop Computer Projector Video Software TV/Monitor Projector Screen Staff member must bring needed equipment

* Required

May 2013