Speaker Request

Are you interested in bringing Jeff in to speak at your church or event? Please fill the form out below and Jeff will get back in touch with you shortly.

Name*
First Last
Email*
Organization Name*
Organization Website*
Organization Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Phone*
Event Information
Type of Event*
Event Location*
Nearest Airport*
Venue Type*
Date Jeff Needs to Arrive*
MM slash DD slash YYYY
Date Jeff Can Leave*
MM slash DD slash YYYY
Expected Attendance*
How Many Times Will Jeff Speak?*
Are There Other Speakers? If Yes, who*
What is the expected honorarium?*
Is there anything else Jeff should know?*
Comments
This field is for validation purposes and should be left unchanged.

Mailing Address

JeremiahCry Ministries
37 Hanover Road
Marlton, NJ 08053

While JeremiahCry Ministries is a non-profit ministry, we are not a registered 501c3 organization with the IRS. This only means that your donations are not tax-deductible.

SPEAKER REQUEST

Event Information

Mailing Address