Speaker Request Form

NCIRD offers dynamic speakers to cover a wide range of immunization topics at meetings, conferences, grand rounds, and other events. Our training is usually intended for health care providers and we offer customized training to meet your needs.

On-Site Speaker 

You can request an on-site speaker from CDC/NCIRD. They will travel to your location and all travel is funded by CDC. We cannot accept any sponsored travel. CDC typically requires a minimum of 150 participants for an on-site speaker.

Please submit your request as early as possible even if you have not determined the exact dates for your training.

We can adjust the dates if needed if it is the same fiscal year.

Distance Learning Options

CDC speakers are available to provide remote presentations using web-based technologies. There are no audience size requirements for distance learning events.


Date of Submission:  
Requested Presentation Date(s):  
On-site Speaker or Distance Learning Speaker:  
Will a Distance Learning Presentation be Acceptable if Travel is Not   Approved:  
Presentation City:  
State/Territory:  
Event Title:  
Event Website URL:  
Topic of Presentation:  
Expected Presentation Time(s):   
Length of Presentation:  
Estimated Number of Attendees:  
Target Audience:  
Hosting Organization:  
Are you Requesting a Specific Speaker?:  
Name of Speaker:  
Contact Person:  
Title:  
Address:  
City:  
State/Territory:  
Zip:  
Phone:  
E-mail:  
Verify E-mail:  
   
Brief Description of Your Event (goals, objectives, etc) and Additional   Comments:  
 
   

Our speakers would also very much appreciate the opportunity to meet with healthcare providers in private (non-public health) practice to discuss their challenges, concerns, best practices, and effective strategies used in providing immunization services to their patients. Please let us know if private providers (and if possible, how many and what types, e.g., physicians, nurses, medical assistants) will either be part of the planned presentation session, and/or if a separate meeting with such providers can be scheduled.

Page last reviewed: June 30, 2020
Content source: June 30, 2020