Speaker Request Form

(Please submit request at least 8 weeks prior to your event.)

Thank you for your interest in the Office of Disease Prevention and Health Promotion (ODPHP) or the President's Council on Sports, Fitness & Nutrition (PCSFN).

If you would like to invite a member of the ODPHP staff or a PCSFN member to participate in your event, please fill out the form below. Please submit your requests at least 8 weeks before your event to allow ample time for processing and scheduling. Note that we can't honor requests for fundraising or meet-and-greets.

Please provide as much of the requested information as possible to help our team make a decision. You may also submit a formal letter of invitation or supporting documents.

Due to the high volume of requests, please await our response to your invitation. You will receive confirmation or declination within 4 weeks of submitting this request. If we are able to meet your request, we will contact you to discuss further details.

OMB Control Number: 0990-0281; Expiration Date: 10/31/2024

What is the requested topic?
(Please select all that apply.)
Have you been working with an ODPHP staff member or PCSFN member on this request?

EVENT INFORMATION

(mm/dd/yyyy)
(Please provide event location details.)
If in person, please provide event location details
Is the event open to the press?
Are federally registered lobbyists or federally registered lobbying organizations invited to the event?
(Ex: Free / $100.00)
Will there be any fundraising at this event?

ORGANIZATION INFORMATION

(Ex: 760-555-1212)
You may submit a formal invitation or supplemental materials that could be useful as we review your request.
Maximum 5 files.
2 MB limit.
Allowed types: pdf, doc, docx.
* Required

Following Up:

We will confirm or decline requests for a PCSFN member or ODPHP staff member to attend your event within 4 weeks of receiving your invitation.

You should not include ODPHP or PCSFN in any promotional materials for your event until we confirm that a member of the Council or our staff will be able to attend. You also should not list a PCSFN member or staff as "invited" until we confirm attendance.

Additional Questions:

If you have additional questions, please use the contact form on the ODPHP website.