Respect Graduate School Guest Questionnaire
Thank you for agreeing to participate in Respect Graduate School’s event. In preparation for this upcoming event, please take a moment to fill out the following form to assist us with your transportation needs and event promotion.

If you need a reimbursement for any event related expense, please contact RGS at info@respectgs.us.

Name *
As it will appear on promotional material.
Your answer
Name *
Your official name on your ID. This will be used for plane tickets, hotel reservations, etc.
Your answer
Phone Number *
Please enter your cell phone number in case we need to contact you in an emergency.
Your answer
Email address *
Your answer
Address *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Cell Phone Number *
Your answer
If you are part of our Colloquium, Khutbah, or Halaqah Series, do you have a title in mind for your talk that we can advertise?
Your answer
If you are part of our Colloquium, Khutbah or Halaqah Series, please enter the summary of your speech in a couple sentences.
Your answer
Short Bio *
Please enter a short bio of yourself for us to use in our promotional material and website.
Your answer
Video Recording & Live Streaming *
RGS would like to record and live stream (if applicable) the event . Do you authorize us to record the event and publish it including, but not limited to, on our website and social media accounts?
Transportation
Will the transportation be arranged by RGS? *
What is your preferred means of transportation?
If by plane, which airport(s) do you want to use for your transportation?
Your answer
When do you want us to schedule your departing flight? (i.e. your flight from your home to RGS)
E.g. "May 14 2018, afternoon" or "May 14 2018, between 1 PM and 5 PM"
Your answer
When do you want us to schedule your return flight? (i.e. your flight from RGS to your home)
E.g. "May 14 2018, afternoon" or "May 14 2018, between 1 PM and 5 PM"
Your answer
Do you have a Known Traveler Number?
If yes, please enter.
Your answer
What is your date of birth?
Your DOB is needed to schedule a flight.
MM
/
DD
/
YYYY
Do you have a meal preference?
This information will be used if your flight has a meal.
Your answer
Is there anyone accompanying you?
Your answer
Any other comments on your transportation needs?
Your answer
Lodging
Will your lodging needs be arranged by RGS? (If applicable) *
When do you want check-in?
E.g. "May 14 2018, afternoon" or "May 14 2018, between 1 PM and 5 PM"
Your answer
When do you want to check-out?
E.g. "May 14 2018, afternoon" or "May 14 2018, between 1 PM and 5 PM"
Your answer
IRS Form W9
Please fill out the W9 form and submit it to the RGS business office. We need the form to release any payments such as honoraria. You can email the form to info@respectgs.us, mail it to 2200 Industrial Dr. Bethlehem PA 18017, or give us in person when you arrive. In any case, no payments will be released without a completed W9.

https://www.irs.gov/pub/irs-pdf/fw9.pdf

Photo
Finally, please send a high resolution photograph of yourself to info@respectgs.us. It will be used for the promotional material including the postings on Facebook, Twitter and Instagram.
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This form was created inside of Respect Graduate School.