Event Information

The Pennsylvania Department of Health (DOH) is in receipt of your request for a representative of the Department to participate in your conference/meeting. Please note that speaking requests are processed on a weekly basis, so please provide the requested information within 48 hours of receiving this form.
Required fields are marked with an asterisk.(*)

Organization’s Point of Contact (POC)

Speech Topic/Stage Set Up

Stage Set Up

Media Information

Executive Order 2015-01 (Gift Ban)

Prohibits Commonwealth employees from accepting the following: refreshments and meals; honoraria, plaques and mementos; travel and lodging; and other gifts. A representative from the Department will contact you to obtain the market value of any meal or refreshments to be offered at the speaking engagement, if applicable. Please also provide the speaker with a receipt indicating payment for the refreshments.
If you have any questions about the gift ban, please contact Executive Deputy Secretary, Peter Blank – pblank@pa.gov