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ECDOH Participation and Presentation Request Form

Please complete this form to request participation, a presentation, and/or materials from the Erie County Department of Health (ECDOH).  If you would like additional information, or have any questions, please contact us at (716) 858-7277 or wellness@erie.gov. 

Please note that submission of this form is not a confirmation of ECDOH participation in an event, and we may not be able to fill all requests. Thank you.

* Fields with an asterisk (*) are required fields.

Event type you are requesting ECDOH participation (select all that apply)
Event Setting (select all that apply)
Topic(s) that you are requesting (select all that apply)
Specifically Breast Cancer, Cervical Cancer, and Colorectal Cancer
Diabetes, hypertension, stroke, etc.
Equipment that you provide (select all that apply)