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
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Ramadan
Khutbah Speaking request only (No Fundraising)
Fundraising
Organization Introductory Appeal and Table Setup
Full Name
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E-mail
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Phone Number
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Organization Name
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Organization Address
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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
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Key Points about your Organization
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Speaker Name
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First Name
Last Name
About Speaker?
Date Requested
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Ramadan
Any open date available
Specific Date
Enter Date
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Month
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Day
Year
Date Requested
Any other comments?
Date Submitted
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Month
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Day
Year
Disclaimer/Agreement
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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.
Submit Form
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