Sh Rami Nsour Speaker Request Form 
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Hosting Organization: *
Event Name *
Organization Representative: *
Organization Location (city, state, country)
Email: *
Point of Contact Phone Number *
Event Format *
If your event is in person, where would it take place?
Date of Event: *
Please ensure the "Date" is in the Pacific Standard Time zone.
MM
/
DD
/
YYYY
Time of Event: *
Please ensure the "time" is in the Pacific Standard Time zone with AM/PM. 
Is your date flexible? *
If yes, what other dates might work for your event?
How long are you requesting Sh Rami to speak for, including Q/A and discussion? *
Will this event require a slide deck or presentation slides? *
Will this event be recorded? *
How many people are you expecting to be in attendance?
What topic would you like Sh Rami to speak on? Please be as specific as possible. *
If you have listed multiple topics, please outline your number one topic of choice.
Website URL *
Social Media URLs *
Which option best describes your organization: *
Please Include Honorarium (USD) Being Offered *
If this is an in-person event, will travel expenses be covered?
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Briefly describe your target audience.
Please list any other speakers (if any available) who will be speaking at this event.
Thank you for inviting Sh Rami to speak. Please allow one week for a response.
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