Thank you for your interest in having Jeremie speak at your event.
Click the "start" button below to give us a few more details.
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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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