Speakers Request Form

Speakers Request Form

Please complete the form below to request a Registered Dietitian for a Health Fair or Speaking Engagement. In order to have adequate time to recruit a member, we prefer all requests be made at least 4 weeks in advance – let us know if you are making a more urgent request and we will try our best to accommodate your situation. Please let us know if your organization will be able to provide an honorarium for the presenter.Once this form is complete, our Speaker’s Bureau Chair will be in touch with you to make further arrangements.
  • MM slash DD slash YYYY
  • Please indicate the topic of interest for this event. Examples include: heart healthy, diabetes, gluten-free, pediatrics, etc.
  • Please indicate and descriptive information for the attendees of the program. Examples include: gender, age, etc.

  • Requested Materials