Speaker Request Form

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Thank you for your interest in arranging a speaker from Physicians for a National Health Program (PNHP). We have speakers around the country, in numerous specialties, available for in-person and virtual presentations. A select list of speakers and their biographies is here, and an expanded list is here [link to a google view-only sheet with name, location, specialty].

Should you have any questions about arranging a speaker from PNHP, please contact organizer@pnhp.org

Email *

Your name *

Hosting institution or event sponsor *

Your role at the institution or event *

Event's location (city, state) *

Event's date or prospective dates *

Your phone number *

What type of engagement are you arranging? *

Grand Rounds

Noon Conference or resident event

Medical student event

Other:

Would you like a speaker who can present in person or virtually? *

In person

Virtual

Either

Other:

What specific topic would you like this presentation to address? *

Are you requesting a specific speaker? *

Yes, but I am open to other speakers who may be available

Yes, and I am only interested in that specific speaker

If you are requesting a specific speaker, please list:

If you would like a speaker from a specific specialty, please list:

Does this engagement pay honorarium or travel expenses? *

Yes

Other:

Any additional comments, requirements, information, or requests?

A copy of your responses will be emailed to the address you provided.

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