Speaker Request Form

Please fill out the form below about your upcoming events. If you have any questions about the form or need assistance, please contact HPIO’s Director of Communications, Alana Clark-Kirk.

Name of your organization

Organization *

Contact Information

Name

Title

Email Address

Phone

Presentation Information

Date + Time

Location

Expected length of remarks

What topic(s) would you like HPIO to address?

Who is the expected audience?

How many people are you expecting?

Is the presentation part of a conference? If yes, will the presentation be a plenary or workshop session? If workshop, how many other sessions are planned for the same time?

Is the presentation part of a panel? If yes, how many other speakers are participating? What other speakers have confirmed their participation on the panel?

Are you able to provide an honorarium for this presentation?

Yes

Does this presentation require travel from Columbus, OH

Yes

Attend HPIO's 2025 Health Policy Summit on Oct. 9, 2025

With limited resources and growing need, investing in policies that deliver the greatest impact is essential. This event will highlight strategies that improve health and wellbeing while reducing healthcare spending. Speakers will provide evidence-informed research responsive to today’s political climate, focusing on what works and why it matters now more than ever.

2025 Ohio Health Policy Summit

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Speaker Request Form

Name of your organization

Contact Information

Presentation Information

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Attend HPIO's 2025 Health Policy Summit on Oct. 9, 2025