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Please fill out the form below to request a speaker.

Tom Randall, Ph.D.

Biography

Privacy Act Statement

The primary use of the collection of your name, your school/organization, 1-2 preferred dates or times, your work email, your cell phone, the street address and city of your organization, and a description of the event is for organizing the event your request. It is optional to provide a preferred speaker, estimate attendance, other topics of interest, and how you heard about this service. If you do not provide this information, you would not be able to be contacted with a correct reply.

Collection of this information is authorized under 42 U.S.C. 203, 241, 289l-1 and 44 U.S.C. 3101, and Section 301 and 493 of the Public Health Service Act. The Privacy Act System of Records Notice (SORN) that covers collection of this information is 09-25-0156 Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIH/OD and 09-90-1901 HHS Correspondence, Comment, Customer Service, and Contact List Records.

Request Speaker

All required fields have the word (Required) after the label.

Your Name (Required)

Your School/Organization (Required)

Your Work Email Address (Required)

Your Cell Phone Number (Required for Last Minute Zoom Problems, Etc) (Required)

Other Topics of Interest (separated by comma) (Optional)

Street Address and City of School/Club (Required)

Preferred Speaker (Required)

2-3 Preferred Dates/Time (Required)

Preferred Location (Required)
Est. Attendance (Optional)
How did you hear about the NIEHS Speakers Bureau? (Optional)
1-2 Sentence Description of Event, Age of Participants, Etc (Required)

Our speakers can travel up to 50 miles from the NIEHS campus in Research Triangle Park, North Carolina. Please allow at least four weeks to make arrangements.

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