Pitt County Forms Center

2.  
   
   
   

   201 Government Circle, Greenville, NC 27834  |  Telephone: 252-902-2300

   Request a Public Health Speaker, Presentation or Event Involvement
    

4. Pitt County Public Health offers presentations and guest speakers for community groups, schools, workplaces, and organizations. Complete this form to let us know your interest. Submitting this request does not guarantee speaker availability. A Pitt County staff member will contact you to discuss scheduling, confirm details, and availability.

6. Organization & Contact Information
8. Group or Organization Name:*
10. Organization Type:*
11. Web Address:
13. Org. Phone Number:*
14. Org. Email Address:*
16. Primary Contact's First & Last Name:*
17. Contact's Affiliation with Organization:*
19. Contact's Phone Number:*
20. Contact's Email Address:*
22. Event Information
24. Event Name:
25. Event Date & Time:
27. Event Type:
28. Primary Audience & Age Range:
30. Event Address/Location:
32. Topic of Interest :
33. Presentation Preferences:
35. Additional Comments or Information:
Leave This Blank:


37. Submit

* indicates a required field