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Event Website / Company Website:

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Where is the event being held? (leave blank if the location has not been set)


Proposed Date of the Event:

Duration of Jerome's Talks (i.e. 30 minutes or 60 minutes):

How many attendees are expected?

Will there be an opportunity to sell books / other products at the event?
YesNoLet's Discuss

Will travel expenses (if required) be covered by the event?
YesNoLet's Discuss

Why do you think Jerome would be a good fit as a speaker at your event?

Is there anything else we should know?