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Illinois Emergency Management Agency and Office of Homeland Security

Speaker Request Form

The Illinois Emergency Management Agency (IEMA) has staff available to speak on a number of topics related to emergency management, homeland security, and nuclear and radiation safety. To request a speaker for your organization or event, complete the form below and provide as much information as possible regarding the event.

The request will be reviewed to determine speaker availability and you will be notified regarding the status of your request. Please contact Kevin Sur, Communications Manager, at 217-557-4756 with questions.

Contact Information and Event Details

* indicates required field

First Name

Last Name

Email Address

Telephone Number

Event Name

Organization Hosting Event

Event Address

Event Start Date

Event Start Time

Event End Date

Event End Time

Speaker Start Date

Speaker Start Time

Speaker End Date

Speaker End Time

Is the presentation time and date flexible?

Yes

Purpose of the Event

Presentation Type

Topic Requested

Description of Audience

Expected Audience Size

Equipment Available at Site

Additional Comments

Attachments

Multiple files can be uploaded by holding down Shift or Ctrl while selecting.

Speaker Request Form

Contact Information and Event Details

CONTACT INFORMATION

USEFUL LINKS

IEMA-OHS MOST REQUESTED

Speaker Request Form

Contact Information and Event Details

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CONTACT INFORMATION

USEFUL LINKS

IEMA-OHS MOST REQUESTED