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Event Request for LDH Leadership

Please Select One

Please complete the form below to request LDH leadership’s attendance or participation in your event.

Please note: During any Legislative Session, LDH Leadership’s appearance is contingent upon that day’s session activities. Though we are eager to fulfill all scheduled speaking engagements, our critical role in public service requires participation in legislative activities, sometimes with very short notice. We appreciate your understanding.

Your Information

Your Name

Your Email Address

Your Phone Number Use the following format: 123-123-1234

Your Organization

Event Information

Event Name

Event Address

Parish

Date of Event

Time of Event For example: 7:00 AM

Dress Code of Event

Number of Attendees Expected

Expected Role

Type of Event Appearance

Topics of Interest

Moderator and/or person introducing

Event Sponsors

Individuals/Organizations to be Recognized

Other Speakers at Event

MC of the Event

Media Details

Bio Needed? Yes
No

Photo Needed? Yes
No

Event Open to Public? Yes
No

Event Open to the Press? Yes
No

Additional Information

Is the Event Local (Baton Rouge, LA) Please provide details.

Expect attendees from out of state/country? Yes
No

Please list elected officials expected to attend

Are elected officials invited? Yes
No

Length of Time Requested to Speak

Is Zoom appearance an option? If so, explain.

Surgeon General Ralph L. Abraham, M.D.

Secretary Bruce D. Greenstein

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