Speaker Request

Please fill out the information below if you would like a professional from Mayo Clinic Health System to speak at your upcoming event. We ask that you submit your request at least 6 weeks in advance. If you have any questions, please contact the community engagement team at SEMNCE@mayo.edu.

Today's Date

Title of Speaking Engagement Opportunity:*

Event format*

Select or enter value

Location & City:*

Date of Speaking Engagement Opportunity:*

Time:*

Contact Name*

Contact Phone Number:*

Contact Email Address:*

Who do you expect to attend the event? (Consider: age, gender, type of work, etc.)*

Number of people expected to attend:*

What topic(s) would you like MCHS to cover?*

Is the event open to the public? (Check the box if yes.)

Is there a cost to attend the event? (Check the box if yes.)

Will COVID-19 safety measures be in place? If so, please describe.

What is the format of the event? (Consider: other speakers, activities, etc.?)*

Has MCHS participated in this event before? If so, please briefly explain our participation*