Healthy California Speaker Request Form
Please fill out the following information to request a speaker from the Healthy California campaign to discuss the Healthy California Act , SB 562 (Lara & Atkins), which will guarantee healthcare for all in California.
Email address *
Event *
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Organization *
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Phone Number *
Your answer
Meeting Date *
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Meeting Location *
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Number of Attendees Expected At Meeting: *
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Meeting Start Time
Time
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Speaker Start Time *
Time
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Is there time for Questions and Answer?
Time allotted to HealthyCA presenter (including Q & A)? *
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Meeting purpose/type
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Has your organization endorsed SB 562? *
Who is the audience? *
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Is media invited? *
Format? *
If Panel, please list others invited to speak:
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Any other details we should be aware of?
Your answer
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