Live Well San Diego Speaker's Bureau Presentation Request Form

Live Well San Diego Speaker's Bureau Presentation Request Form

Your first step on the path to health starts with a Live Well San Diego Speaker's Bureau presentation!

This program will be sunsetting on June 30th, 2024.

We will not be able to support requests past this date. We thank you for your many years of partnership, and dedication to improving health literacy within the county.

Contact Name*

Please provide first and last name.

Contact Email*

Contact Phone Number*

Organization Details

Organization/Group*

Zip Code*

Organization Type*

Select

If Other, Please Explain:

Topic*

My group is interested in learning more about:

Preferred dates or days of the week you are looking for a speaker?*

Please share if you have a specific date in mind, or if you have multiple days of the week you are open for a presentation. You can put a monthly date if this is part of a monthly meeting, or multiple days of the week if you have various days you are looking to fill with activities

Potential Timeframes for Each Specific Date/Day

Please put the timeframe you are requesting the presentation to be for. Presentations can be anywhere between 30 minutes to an hour. If you have multiple days available, please put the time frame for each day if they are different.

In-person or Virtual Training*

Select or enter value

If in person, what is the address?

Does your organization currently offer webinars to clients and staff?*

Select or enter value

Presentation Language*

Interpreters are available to assist with presentations in several languages.

Audience Details*

Please provide a BRIEF description of your audience.

Requester Comments

What other information you would like to provide?

Send me a copy of my responses

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