Request Form – Majed Mahmoud

May Allah bless you. Please complete the form below and provide as much information as possible. We will get back to you soon, in shaa Allah.

Contact


Person's Name *

Email *

Phone Number *

Organization's Name *

Organization's Address *

Event Logistics


Type *

Theme *
Proposed topics and ideas

Date *

Location *
Street Address, City, State / Province / Region, Zip Code, Country

Time *
Example: 11:00 AM
:

Expected Number of Attendees *

Other Speakers Invited *

Other


Honorarium *
If the organization doesn’t provide an honorarium please type “0” zero.

Are expenses covered by The Invitee? *
For example: transportation, accommodation… etc.
 Yes No, the speaker needs to pay for the expenses

Comments
Please feel free to add more information about the event or mention any special requests

Thank You

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