Department of Public Health
Speakers' Bureau Community Request Form     (*Required Fields)

Complete this form to request a Speakers' Bureau presentation or Hands Only CPR Training. Please note presentations are fulfilled on a first-come, first-served basis. Submitting a request does not guarantee a presenter can attend your event. However, submitting three weeks or more in advance will improve our ability to accommodate your needs. You will receive an e-mail or phone call accepting or declining your invitation within 7-10 business days of submitting this request. You will also receive a confirmation number for request tracking purposes.

*Note: Virtual COVID-19 presentations can be scheduled 2 weeks in advance. Requestors, please select the earliest date available and then in the notes section indicate preferred date.

IMPORTANT: All Speakers’ Bureau presentations have been prepared for general community audiences unless otherwise noted on the Speaker's Bureau webpage. If you require a presentation that’s intended for health professionals and other clinical audiences, please make a note of this in the comments section of the request form and provide specific information about the audience type you’d like us to serve through the presentation. Once again, submitting a request does not guarantee a presenter can attend your event.

If you are experiencing technical issues using this form, please download the PDF version of the request form and submit it by email to Thank you!

Attention DPH Staff: Do not use this form to report participation in an outreach event that's not related to Speakers' Bureau. Instead, please use the DPH Staff Participation in Outreach Event form located online at Only report outreach events that you've participated in the past (do not include future outreach events). Thank you!

Requester Information

1. Today's Date: 12/01/2023
2. * First Name:
3. * Last Name:
4. * Organization or Department:
5. * Phone Number: 555-555-5555
6. * E-mail:
7. * How did you hear about us? Department of Public Health Website
Health Education Administration Website

Event Information

8. * What topic would you like us to present at your event?         
9. What kind of event would you like us to attend?

Note: Please indicate if this is a request for a lecture or a health fair.
Community Meeting
Health Fair
Professional Meeting
Virtual Event
10. * What date are you proposing?    (Event date no sooner than 3 weeks or 3 months after today)
Note: We need to know about the event at least 3 or 4 weeks in advance to try to accommodate this request. Due to an increased demand for outreach events during flu season (October-March), may ask to reschedule your event.
11. * What times are you proposing? (start time between 8:00A.M - 4:00P.M Only)
12. How much time would we have to present? (If less than 1 hour, please indicate time in Comments section)
13. * How many people do you expect will attend your event?
Note: Events with less than 20 participants cannot be accommodated.
14. Who will attend your event?
Note: Remember to check all that apply.
Business Representatives
Community-Based Organization Representatives
College-Age Students
Elementary School-Age Students
Faith-Based Group
Government Agency Representatives
Health Professionals
High School-Age Students
Los Angeles County Employees

15. Is this event open to the public? Yes
16. What is the address of where your event will take place?
* Street Address:
* City:
* Zip Code:

17. Do you need this presentation in Spanish?
Note: Some materials are only available in English at this time.  
Remember, you will receive an e-mail or phone call accepting or declining your invitation within 5 business days of submitting this request.

Please note: if you do not see a confirmation page within a few minutes after clicking on the submit button, it means we did not receive your request. Please try submitting your request again."
Public Health has made reasonable efforts to provide accurate translation. However, no computerized translation is perfect and is not intended to replace traditional translation methods. If questions arise concerning the accuracy of the information, please refer to the English edition of the website, which is the official version.
Los Angeles County Seal: Enriching lives through effective and caring services