Community Event and Speaker Request Form

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Welcome to the SMCHD Community Event and Speaker Request Form! Thank you for your interest in partnering with the St. Mary's County Health Department for your upcoming event. To request that the Department participate in your event as a speaker/vendor or provide materials, please complete the event request form at least two weeks prior to the event. All requests are reviewed once received. Our ability to honor your request is based on staffing and date. The form is a notification to the St. Mary's County Health Department and not a confirmation that the Department will participate. 

If you have any questions or cannot fill out the online form, call 301-475-4330.

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Name *
Email *
Phone Number *
Preferred Contact Method *
Event Host Organization *
Event Name *
Event Webpage
What is the theme of your event?
Date of the Event *
MM
/
DD
/
YYYY
Time of the Event *
Event Location
Number of Attendees Expected?
What type of representation from the St. Mary's county Health Department are you seeking for your event?
Please select all that apply.
If seeking a speaker on a specific topic, what is the requested topic?
Is there any other information you would like us to know?
Submit
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