Event Requests - Florida Department of Health in Sarasota County

Speakers Bureau, Health Fairs, and Special Events Request Form

Please complete this form to request a guest speaker, participation in a health fair or special event, including the Health In Motion Mobile Medical Unit.

* These areas are required for your request to be considered.

Under Florida law, e-mail addresses are public records. If you do not want your e-mail 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.

Comments

This field is for validation purposes and should be left unchanged.

Today's Date

Name of Event(Required)

Nature of Request(Required)

If "Other" please explain:

Type of Event(Required)

If "Other" please explain:

Target Audience (check all that apply)

General

Children

Teens

Adults

Seniors

Estimated Number of People Attending(Required)

Program Location Name(Required)

Address of Program(Required)

Street Address Address Line 2 City State ZIP Code

Event Date(Required)

Event Location(Required)

Event Start Time(Required)

Event End Time(Required)

What other service providers be present?(Required)

How will the event be promoted?

Please include information on use of traditional media, social media, organizational emails or newsletters, and any other form of advertising?

Name(Required)

First Last

Organization Name (if applicable)

Organization Address/City(Required)

Street Address Address Line 2 City State ZIP Code

Contact Phone(Required)

Contact Email

Please note: Florida has a very broad public records law. Most written communications to or from state officials regarding state business are public records available to the public and media upon request. Your e-mail communications may therefore be subject to public disclosure.