Speaker Request Form

To request an ADAMH representative to speak at your event, please fill out the form below. Please note: the event must be in Franklin County. If you would like to request ADAMH resources for your event, please visit our Event Resources page.

Contact Name*
First Last
Contact Email*
Contact Phone Number*
Event Name*
Event Purpose
Date*
MM slash DD slash YYYY
Time

: Hours

Minutes

AM/PM
Call-in / Online Meeting Event Information
Event Location Address (for in-person events)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parking instructions (for in-person events):
Number of attendees and audience makeup:*
Dignitaries/VIPs attending:
Event Sponsors:
Organization Name*
Organization Background
What time will the ADAMH representative be expected to speak?*
What is the allotted time for remarks?*
Are there any specific topics you would like to have addressed?*
Program Outline / Agenda
Who will be introducing the ADAMH representative?
Will the ADAMH representative introduce anyone at the end of their remarks?
Will there be audience Q&A time?
Communications & Social Media
When using social media to promote ADAMH's participation in your event, we encourage you to use the official social media platforms of ADAMH. Facebook: facebook.com/ADAMHFranklin Twitter: twitter.com/ADAMHFranklin Instagram: instagram.com/adamhfranklin/ LinkedIn: linkedin.com/company/adamhfranklin Please list any official social media accounts that we should tag if making a post about the event and any hashtags associated with this event.
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