Speaking Request - J.A. Medders

If you would like to have Jeff speak at your event, please fill out this form, the best you can, and we will be in touch.

Main Point of Contact(required)

Email(required)

Website

Phone

Start Date(required)

End Date(required)

What is the name of the event?

Where is the event located?(required)

Event website?

Who is sponsoring the event?

Is this event open to the general public or by invitation only?

If any, who are the other speakers?

How many attendees do you expect?

Who is the target audience?

How many times would you like Jeff to speak? Can you provide a mock schedule?(required)

What specific topics/subjects would you like Jeff to cover?

Are you able to cover travel expenses?(required) Yes

Working on it

If no, please explain

Honorarium Amount(required)

When do you need a formal commitment by?

Any other questions or comments?