Speaker Request If you would like an IMAN staff member to speak at your engagement, please use the following request form. All inquiries will be answered within one week’s time. Thank you for your consideration. Name of Person Requested to Speak * Name of Organization * Title of Event/Theme * Date * Location * Specific Room Suggested Title/Topic * Start and End Time for Event * Start and End Time for Speaker * Are there any other speakers? * Yes No If yes, what are the name(s)? Please describe the expected audience (ex. youth, college students, number of people, gender ratio, any other known information) * Is there an honorarium? * Yes No For Dr. Rami Nashashibi: Chicago, national and international events require covering transportation costs and an honorarium ranging generally from $1,500 to $5,000. For other staff: Transportation costs and an honorarium ranging generally from $250 to $500. Honorarium Amount * Contact Person 1 * Phone Number * Email * Contact Person 2 Phone Number Email May the speaker bring literature/informational material about IMAN to the event? * Yes No Emergency Withdrawal Agreement * Yes Yes, I understand that confirmed speaking engagements are placed in the internal IMAN calendar immediately. Though IMAN staff members do their utmost to honor a confirmed speaking engagement, there are some extenuating circumstances that may require him/her to pull out of an engagement. This is an extremely rare occurrence but if a retraction is necessary, IMAN will do its best to contact you immediately and, if possible, assist in finding a replacement speaker.