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2. Health Promotion has well-qualified and experienced Health Promotion Specialists who are able to bring engaging and educational presentations to your organization. Please complete the following fields to submit a request for a health presentation at your organization. A member of Health Promotion staff will contact you within three working days of your request being received. For further information please call (309) 888-5446.

4. Your Name:*
5. Your Email:*
7. Your Phone:*
8. Organization:*
10. Health Topic:*
    -- Select One --Handwashing/HygieneHealthy eating/Active livingTobacco/Vaping
11. Target Audience:*
13. Desired Date of Presentation:*
    Desired Date of Presentation:
14. Desired Length of Presentation:*

    Ex: 30 minutes, 1 hour, etc.

16. Please provide any additional comments or details
Leave This Blank:


18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit Submit and Print

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