Form - Speakers Bureau Request

WakeMed Health & Hospitals offers a speakers bureau as a part of our commitment to the Wake County community. Please note that all requests should be submitted at least 30 days prior to the event and a minimum of 20 adults is requested as an audience. By providing the information below, it will help us match your needs with a great speaker faster.

Primary Contact Name

Name of Requesting Organization

Email Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Organization Website

Requested Topic (If none specified, we can provide recommendations)

Presentation Format (PowerPoint, Panel Discussion, etc.)

Amount of Time Allotted for Presentation (including question and answer session)

Is the presentation part of a regularly scheduled meeting or a larger event?

If YES, please describe:

Date Event Will Take Place

Language 1

Language 2

Language 3

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Form - Speakers Bureau Request