Speaker Request Form Speaker Request Form (No Honorarium) Name of Person Requested to Speak * Name of Organization * Title of Event/Theme * Date * Location * Suggested Title/Topic of Speech * Start and End Time for Event * Start and End Time for Speaker * Are there any other speakers? * Yes No If yes, what are their name(s)? Please describe the expected audience (ex. youth, college students, number of people, gender ratio, any other known information) * 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 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.