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Speaker Request
To request a speaker for one of your events. Please complete this form and we will get in touch with you. This information will make it easier to schedule a speaker and ensure a smooth program inshaa Allah.
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* Indicates required question
Organization Name
*
Please enter the name of your organization
Your answer
Point of Contact
*
Please enter the name of the person requesting a speaker
Your answer
Tel
*
Please enter your telephone
Your answer
Email
*
Please enter your email
Your answer
Please enter your organization's/group website
*
If you dont have one enter none, and send us a short bio bout your organization
Your answer
Date of Event
*
Please enter the date of your event
Your answer
What is the Start Time of the Event
*
Your answer
What is the duration of the Event?
*
From Start to End in Hrs
Your answer
Location of the Event
*
Please enter complete St Address, Building Name, city, state/province and country ( include room number and floors)
Your answer
Event Type
*
Please choose the type of your event
Fundraiser
Youth Program
Parent Program
Educator's Program
Newspaper / Radio / TV Interview
New Muslims Dawaa
Sisters Only
Non Muslims
Incarcerated Muslims
University / College MSA
High School Visit
Community Bazaar / Dinner / Social Gathering
Jummah Khutbah
Other:
Speaker Invited (if no one specifically leave blank)
Your answer
Event Topic / Theme
*
Please be specific and keep your response to no more than 8 lines.
Your answer
Is there a particular challenge or message you would like the speaker to convey? If so, please provide some information and background.
*
Your answer
Attendee Demographics
*
Please provide us with information related to (1) Average No. of Attendees, (2) Gender, (3) Age, (4) Ethnic Background
Your answer
Is Event in a Restricted Access Area?
*
Enter Yes if security check points, queue lines, checkin, sign in or registration is needed
Choose
Yes
No
Please provide details on parking
*
Location, fees and distance from venue
Your answer
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