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PCSFN Speaking Engagement Request Form

(Please submit request at least 8 weeks prior to your event.)

If you are interested in inviting a Council member, our Executive Director, or one of our staff to speak at your event, please fill out the Speaker Request Form. Requests for Council participation should be submitted at least eight (8) weeks prior to your event to allow ample time for processing and scheduling of your request.

Please provide as much of the requested information as possible. After we receive the completed form, we will determine if a speaker is available for the event. If we are able to attend the event, we will contact you to discuss further details. Due to the high volume of requests, please wait to hear from us. Thank you for your interest in the President’s Council on Sports, Fitness & Nutrition.

Questions related to this form can be directed to our Acting Director of Communications, Joey King at russell.king@hhs.gov.

Organization Information

Today's Date:
Is the organization located in the U.S.?:
Is the organization extending the invitation to a federally registered lobbying organization?
If yes, is the organization extending the invitation to a 501(c)(3) tax exempt organization under the federal Internal Revenue Code, or a media organization?
Is the individual extending the invitation a federally registered lobbyist?

Event Information

Event Date:
Event Start Time:
Event End Time:
Is the event a charitable fundraiser?:
Has PCSFN participated in your event in the past?:
If Requested Speaker is unavailable, is a Surrogate Requested?:
Time of Speech:
Indoor or Outdoor?
Additional Speakers at Event, if any:
Open, Closed or Invited Press?:
Have Any Press Confirmed Attendance?:
Meeting Attire:
Audio-Visual (Please check all that will be available):
If speaker uses a PowerPoint presentation the file should be provided on (Please check):
Is a spouse or other guest invited?
If yes, will others in attendance generally be accompanied by a spouse or other guest?