About You
First Name
Last Name
Phone Number
Email Address
Your Organization
Organization Name
Organization Website
Type of Organization
Elementary School
Middle School
High School
College/University/Professional School
Religious Institution/House of Worship
Community Organization
Senior Residence or Organization
Professional Organization (Medical, Legal, etc)
Government/Law Enforcement
Corporation
Where will the program take place?
Street Address
City
State
Zip
Estimated Size of Audience
Type of Program
In person speaker
Virtual presentation
Film or other program
Dates/Time Requested:
1st Choice
2nd Choice
3rd Choice
Requested Length of Presentation
45 - 60 minutes
60 - 90 minutes
Requested Content
American Muslims: Beliefs and Practices
Muslim Women: Past Present & Future
Ramadan Demystified
The Quran Explained
Cultural Competency for Law Enforcement
Cultural Competency for Medical Professionals
Other
Other information that would be helpful in planning for the presentation
Your Budget for Honorarium
Enter a whole number only, for example, 1, 100, 500, 1000.
Submit