Requester Name

Organization Name

Address

City

State

Zip

Phone

Email

Best Time to Call

Presentation Requested

• American Muslims: Beliefs and Practices
• Roots and History of American Muslims
• What the World Would Be Like Without Muslims?
• Muslim Women: Past, Present and Future
• The Quran Explained
• Mohammad: Prophet of Islam
• Ramadan Demystified
• Muslim Holidays
• Hajj
• Law Enforcement - Cultural Competency for Law Enforcement: Working with American Muslims
• Healthcare - Cultural Competency for Healthcare: Working with Muslim Patients and Their Families
• Children's Program
• Custom Presentation
• ARISE - Suggested for Muslim Community
• Straight Talk Part 1 (youth workshop) - Suggested for Muslim Community
• Straight Talk part 2 (parent workshop) - Suggested for Muslim Community

If Custom, please specify

Duration

Size of Audience (per class if students)

Presentation Preferred Date

Presentation Optional Date 1

Presentation Optional Date 2

Desired Outcome

1st Presentation Begin Time

1st Presentation End Time

2nd Presentation Begin Time

2nd Presentation End Time

How did you hear about the ISB? (please be specific)

Additional Comments

Please Respond By This Date

Your budget for honorarium:

first_name

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