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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:
Can the speaker request
a Sign in Sheet:
Can the speaker distribute literature:
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: