Speaker Requests

Fill out this form to request a speaker. After submission, your information will be forwarded to OSHA’s Office of Communications, who will follow up with you. To best evaluate the speaking opportunity, please make sure any supporting documents, such as a flyer or proposed agenda, are available for this request.

Speaking engagements include but are not limited to summits, webinars, conferences, conventions, testimony before state legislatures, press conferences, and any event with an external audience.

We look forward to working with you.

The fields indicated with an asterisk (*) are required to complete your submission.

Speaking Request

Request Submission Date:

Request Representative From:

David Keeling, Assistant Secretary

Amanda Wood Laihow, Deputy Assistant Secretary

Tonya Ford, National Family Liaison

Other

Event Information

Event Name:

Event Date:

Event Time:

Time Zone:

Time Speaker Will Speak:

In-Person/Virtual:

In-Person

Virtual

Location:

Address:

City:

State:

Zip Code:

Web Address to Virtual Event:

Event Type:

Specify other event type:

Hosting Organization

What is the role of the speaker (i.e., keynote, panelist, etc.)?

Is there a cost associated with this event?

Yes

Is it for profit or non-profit?

Profit

Non-Profit

Open to the public?

Yes

Open to the press?

Yes

Industry/Group:

Select Industry:

Audience Size:

Discussion Topic:

Length of Speech:

Will there be questions and answers?

Yes

Key Messages to Convey:

Point of Contact

First Name:

Last Name:

Title:

Email Address: