Pinellas County Speakers Form

Speaker Request Application

To request a Pinellas County Speaker for your meeting or event, simply complete and submit this form.
You will be contacted shortly after your application is received.
For further information or assistance call the Pinellas County Communications Department at 464-4600.

Requester Contact Information

* Contact Name

* Phone/Cell

* Address

Fax

* City

* Zip Code

* Email Address

Speaker Request Information

* Topic/Title

* Organization Name

* Speaking Location Address

* Age Group

* Presentation Date

* Audience Size

* Speaker’s Presentation Start Time

* Length

Where did you find out about this presentation?
Newspaper
Radio
TV
Internet
Group/Organization
Other:

Meal Included? Yes No

Comments

*your e-mail address is required to submit form

E-mail addresses are public records under Florida law and are not exempt from public-records requirements. If you do not want your e-mail address to be subject to being released pursuant to a public-records request, do not send electronic mail to this entity. Instead, contact this office by telephone (main number is 727-464-3000) or in writing, via the United States Postal Service.