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Speaker Request and Contact Form

Requester name * Company/Organization name * Email address please * Phone number Event Name Event Date Event Time (Start time, End time) Event Location (Address, City, ST) *

Event Type

	Health Fair
	Expert Speaker
	Demonstration Expo
	School/Educational
	Community Organization Sponosored Event

Requested topic Expected Audience Size Comments/Information

Thank you for your request. Free Condoms and Lollipops will be in touch with you within 24-48 hours. If you need immediate assistance, please contact us at 404.593.5597.

Further information

Free Condoms and Lollipops is committed to community engagement. We would love to share health information with the community in fun, engaging and entertaining ways. If you would like to invite Free Condoms and Lollipops to promote or speak at your community event, please let us know!

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Speaker Request and Contact Form

Further information