Speaker Request Form If you are interested in a speaker from the National LGBT Health Education Center for an event or presentation, please provide additional information in the form below. Contact Information: Name (required) Email (required) Phone Number Who is the intended audience and what is the size of audience? (Clinicians, front-line staff, medical students, etc.) Is there a particular topic you would like the speaker to address? (Ex: SO/GI data collection, transgender health, etc.) Do you have proposed dates or a timeline for speaker or program, and is it flexible? Are you open to having a remote presentation via webinar? Do you have funding that you are able to put toward a speaker? What prompted you to seek a speaker on LGBTQIA+ health?
