Thank you for your interest in having Jeremie speak at your event.
Click the "start" button below to give us a few more details.
What is your first & last name? *

What is the best phone number to call regarding the event? *

What is the name of your organization or event? *

If both are relevant, please include them.
What are the dates for the event? *

Please indicate the date(s) you are requesting for Jeremie to speak.
Approximately how many people will attend the event? *

What topic are you most interested in having Jeremie speak on? *

Please give us an overview of the event and any other details that might be helpful.

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