Speakers Bureau Request Form

MidMichigan Health experts are available to share health information with community organizations, church groups, service clubs, schools and other audiences. Use this form to request a MidMichigan speaker for your meeting or event. Please give us at least 6 weeks notice prior to your event.

If you have any questions, please call MidMichigan Health at (989) 839-3000 and ask for the Community Education Manager.
* Denotes required fields

Your Contact Information

Contact Person

Event Details

Desired Topics

General Education (Please select your top three choices.)
Health Screening (Please check all that apply.)

Additional Comments