Request a Speaker

MAMH will assist (at no charge) in organizing a forum or event on:

Advocacy
Mental illnesses, whether a discussion in general or on a specific illness
Suicide
Adverse Health Risk Behaviors
Trauma
Or any topic related to mental health

We can help in obtaining speakers who are clinicians, mental health consumers, family members, or advocates.

While we will assist with forums in which continuing education credits will be offered, please do not ask us to be responsible for securing the credits or necessary certification.

First Name:

Last Name:

E-Mail:

Street:

City:

State:

Zip Code:

Telephone:

Fax:

Preferred method of contact:

Telephone
Email
Fax
Mail

Please briefly outline your concept for the forum. Include subject matter, target audience, expected number in attendance, desired number of speakers and approximate start and end times)

Summary:

Location (if known):

Event Date (if known):

Please specify the format you had in mind for the forum:

Lecture with or without powerpoint presentation
Panel discussion
Town meeting format
Other

Captcha Image (Security Code):

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