EPIC Speaking/Fundraising Request

EPIC Speaking/Fundraising Request

Assalaamu Alaikum (Peace be with you),Please fill out the form below to request a Speaking Opportunity and/or Fundraiser at EPIC
Select a Choice *

Khutbah Speaking request only (No Fundraising) Fundraising Organization Introductory Appeal and Table Setup
Full Name *
E-mail *
Phone Number *
Organization Name *
Organization Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Is your organization non-profit (501c3)?

Yes No
If 501c3, enter TAX ID Number *
Key Points about your Organization *
Speaker Name *

First Name Last Name
About Speaker?
Date Requested *

Ramadan Any open date available Specific Date
Enter Date *

Month Day Year
Date Requested
Any other comments?
Date Submitted

Month Day Year
Disclaimer/Agreement *

I understand this request is not final until written authorization is given by the EPIC Board. In case of violation of any EPIC policies and procedures, approval granted under this application will be terminated immediately at the discretion of EPIC Board.
Should be Empty: