Opioid speaker request form
Philadelphia is facing the greatest public health crisis in a century.

Every neighborhood in the city is being hit hard by an epidemic of substance use and overdose. In 2017, over 1,200 people died from drug overdoses in Philadelphia alone, and thousands more struggled with addiction and the health consequences of it. This crisis has impacted all of us.

To raise awareness about this public health crisis, the City is offering speakers to give presentations at faith-based organizations, community groups, neighborhood associations and schools. These presentations include:
• An overview of opioids – what they are and why they are dangerous
• How Philadelphia has been impacted by opioids and other drugs
• What the City and its partners are doing to combat the crisis
• What you can do to help

All presentations include time for Q&A and discussion.

Most presentations are between 1-1.5 hours (including Q&A and discussion), but they can be requested for any length of time. With advance notice, speakers are available most days and times. Some suggested engagements based on previous events include:
• Weekend presentations after religious services
• Afternoon presentations for corporate/school groups
• Evening presentations for community organizations

Speakers are employees of the City of Philadelphia with expertise in the opioid crisis. There is no cost for speaking engagements.

If you are interested in having a speaker join you, please fill out the speaker request form below. Questions can be sent to dph.opioid@phila.gov.

Please note that unless requested, these educational sessions do not include training specifically on the use of naloxone, the life-saving medication that reverses opioid overdoses. A minimum of 2 hours is required for both opioid education and naloxone training. The City and its partners also offer free naloxone trainings for the public several times a month. The schedule for these trainings is online at: http://www.phillynaloxone.com.

Name of requesting contact person *
Your answer
Phone number of requesting person *
Your answer
Email of requesting person *
Your answer
Name of requesting organization *
Your answer
Address of event *
Your answer
Date(s) and times requested *
Your answer
How many people you anticipate attending *
Your answer
Questions you and your organization are seeking responses to (please be as specific as possible to ensure the speakers are prepared)
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service