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Find out what is happening at your local American Heart area

Speaker Request Form for Austin

Because we rely on a specialized group of dedicated volunteer professionals to fulfill your requests, we ask that you please note the following requirements:

* required fields.

*First Name
*Last Name
*Address 1
Address 2
*City
*State:
*Zip Code
*Day Phone
*Night Phone
Email
*Event Date
*Event Time
*Location
(Please include event location and city)
Event Purpose
Type of Event
* Topics for discussion: Please select all that may apply.  
Heart Attack and Stroke
     Prevention, early warning signs and rehabilitation.
Women and Heart Disease
     Warning signs, prevention and special effects.
Minorities and Heart Disease
     African-Americans and why they are at risk; Hispanics
     and why they are at risk; Heart disease, diet and diabetes.
Research
     New discoveries; Medical innovations and breakthroughs.
Fitness
     Benefits of exercise, how to get started and how
     to persevere for the long-term.
Nutrition
     How to prepare heart-healthy meals, weight control,
     exercise and sodium reduction.
Cholesterol and High Blood Pressure
     What it is, what causes it and how best to control it.
Smoking
     How it affects your body, how it affects those
     around you and how to control it.
Requested length of presentation:
Audience Description:
Is audio/video equipment available?  Yes          No
If YES, please list.
Will media be invited?  Yes          No
Will Legislators be invited?  Yes          No
If YES, please list.
Is this meeting open to the general public?  Yes          No