Presentation Request Form
Thank you for your interest in a presentation from Collin County Health Care Services. Please fill out the following form as completely as possible. Requests are filled based on the availability of the team. Please submit at least 30 days prior to the requested presentation. Please understand that a request does not assure availability. Thank you for your understanding.
Contact Information
Your Name
*
First Name
Last Name
Your Organization/Group
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Presentation Information
Requested team(s)
*
Public Health Emergency Preparedness
Other
Date/Time Preference 1
*
Add a secondary presentation date
Date/Time Preference 2
Select what equipment you will have available for us to present with (select all that apply)
Computer/Laptop
Projector for Computer
TV
Tables
Chairs
None
Presentation Location
Include building name and room number
Audience Information
Please share information about the audience for this requested presentation.
Class, Group, or Organization Name
Estimated Attendance
Please Select
< 10
10-20
20-40
40-75
75+
Audience Demographic Information
What will the audience consist of? (Students, public health professionals, etc.)
Advertising Plan
Please describe how you will be advertising this presentation to your audience. Please note that Collin County Health Care Services does not provide advertising.
Additional Information
Please include any additional information you would like to share with us about your request. This can be any special requests or any specifics you would like us to include in the presentation.
Submit
Should be Empty: