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Request Muslim Speaker for your Event

Getting to know you :

Your Name*:
Organization Name*:
Organization Address*:
Contact Person if not you:
Contact Email/Phone/Address:
Email:

Event Details:

Topic/Purpose of the event:
Event Date:
Event Start Time:
Event End Time:
If the event is all day or goes through Prayer time, where can speakers pray:

Event Style: (Check all that apply)	Lecture QA Lecture and QA Townhall meeting Interfaith Meeting Other

Number of speakers requested:
Preferred Speaker Gender:
If Multiple Speakers requested are they concurrent or one at a time:

Event Logistics:

Is additional time needed to setup event hall: (Check all that apply)	Need computer to setup Need Projector
Describe Parking:
Is Reception Desk check in required:	Yes No
Can the speaker request a Sign in Sheet:	Yes No
Can the speaker distribute literature:	Yes No
How?:
Literature Style: (Hold Ctrl key for multiple)	Pamphlets Booklets Books Quran copies Other

Audience Info:

Audience Size:
Audience age range:
Audience knowledge of Islam:
Is there any specific questions posted by the audience: