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:

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