Date request made: (required)
Response needed by: (required)
Organization Name: (required)
Contact Person: (required)
Contact’s Relationship to Organization: (required)
Phone: (required)
Email: (required)
Fax:
Web:
Type of Event (check all that apply): Single Topical SpeakerCourse TeacherConferenceFundraiserSeminarOther
Event Location (address): (required)
Event date and time: (required)
Type of Audience (check all that apply): MaleFemaleMuslimsMembers of other faithsYouthAdults
Will this speech be (check all that apply): Audio RecordedVideo RecordedTranscribedLive-StreamedNo Recording
Will the media cover this event?: (required)
Amount of people expected: (required)
Type of Speech: (required) Informational / Educational MessageSermon / KhutbahDebateEmcee / FacilitatorTrainingWorkshop Inspirational MessageOther
PowerPoint screen & projector will be available: (required) YesNo
Topic(s) Requested: (required)
Goal for Speech or Message: (required)
Contact Person Handling Logistics: (required)
Phone Numbers: (required)
Transportation & accommodations expenses provided?: (required) GasRental CarTrain FareAir FareHotel AccommodationMealsNone
YesNo
If you have any questions please contact; Ali Erman Phone: 516-359-7053 Email: aeeyuboglu@gmail.com