Philadelphia Department of Public Health

Coronavirus Disease 2019 (COVID-19)

Speaker and Training Request Form


The Philadelphia Department of Public Health (PDPH) is ready and able to provide instructional information and content related to the City's response to Coronavirus Disease 2019 (COVID-19) that will help to keep both you, your agency and your constituents healthy and safe.

Please complete the request form below to provide additional information about your agency and the event that staff would be attending/speaking at. A PDPH staff member will be in touch as soon as they can.

Event Information

 

Event Name:


Event Date:


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Event Time:


Primary Audience:


Expected Number of Attendees:


Agency Information

 

Agency Name:


Agency Type:


Agency Address:


Agency Contact Information

 

Contact Name:


Position / Title:


Phone:


Email Address:


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