Environmental Protection Commission of Hillsborough County
Roger P. Stewart Center
3629 Queen Palm Drive · Tampa, FL 33619
Ph: (813) 627-2600 · Fax: (813) 627-2630

EPC Speaker Request Form

If you would like to schedule a speaker for your school or event, please fill out and submit this form.

Requestor's Name *

Phone Number

Organization

Contact (if other than Requestor)

Email Address

Proposed Speaking Date * +

Proposed Speaking Start Time *

Proposed Length *

Subject *

Target Audience

Expected Number of Attendance

Additional Comments (if any)

Receive email copy?

Check to receive an email copy of this completed form.

Email Address

Disclaimer (required) *

I understand the fulfillment of a speaker will depend upon staff availability.