Speaker Request Form
Thank you for your invitation! We will do our best to accommodate your request. Let's start with a few details...
Event Information
Event Name
*
Event Address
*
Approximate Number in Attendance
*
Approximate Length of Presentation (Without Q&A)
*
Approximate Length of Q&A
*
Event Date and Time
List up to three possible dates & times in preferred order.
Preferred Date & Time
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Date & Time Option 2
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Date & Time Option 3
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Confirmed Date & Time
Presentation Topic (Note: depending on desired length of presentation, EACH topic takes between 20-60 minutes. Please keep this in mind if you are requesting more than one topic.)
*
General Information and History of CHE
Place Matters
ACEs and Places (available after November 1, 2026)
City Health Scorecard (available after September 1, 2026)
Other
Audio Visual & Technology
A CHE presentation requires the capacity for a PowerPoint presentation.
Please indicate what equipment will be on-site and ready for the presenter
*
Computer
Projector
Screen/Wall
TV w/ HDMI cable
Other
Does the location have a microphone
*
Lapel (preferred)
Handheld
Lectern
Not Needed
Parking
If parking permit is needed, please email it to freleri.armstrong@chelincoln.org
Where should the presenter park?
*
Other Details
Please provide us with any other important details.
Event Contact Information
Organization
*
Primary Contact
*
First Name
Last Name
Primary Contact's Phone Number
*
Primary Contact's Email
*
example@example.com
Audience Members
*
Students
Community Members/Stakeholders
Faculty/Staff
Open to the Public
Other
Submission of this form is not a confirmation. A response from CHE will be sent by email within 3 business days following receipt of your request.
If you have not received a confirmation, please contact CHE at 402-436-5516.
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