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This form is a preliminary tool for gathering information; it is not a confirmation of your speaking engagement. After you submit this form, we will email you to discuss the options.

  • Kaiser Permanente International may collect personal information that you voluntarily share with us (for example your name, email address, job title, and employer). We use this information for business purposes including planning and marketing educational programs and speaking engagements. We do not share this information with third parties.
  • Your Contact Information

  • Goals of Your Event

  • Date and Location

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