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MAPS-AMEN Speaker Request Form
To request a speaker, please fill out the form below.
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* Indicates required question
Email
*
Your email
Name
*
Your answer
Host Organization
Your answer
Contact's relationship to organization
Your answer
Contact Phone Number
*
Your answer
Organization Website
Your answer
Who are you seeking as a speaker?
*
Aneelah Afzali
Theresa Creculius
Any qualified speaker on topic requested
A panel of speakers
Other:
Role Requested
*
Speaker / Presenter
Facilitator
Emcee / Host
Brand Ambassador
Other:
Type of Event
Lecture
Workshop
Retreat
Seminar
Panel Discussion
Banquet
Sermon
Debate
Other:
Clear selection
Are you seeking any of the following programs?
*
"Facts Over Fear" Training
"Faith Over Fear" Roadshow
"Sharing Our Stories" Event
Combating Islamophobia Workshop
Being An Effective Ally Workshop
Answering Difficult Questions
Effective Messaging Workshop
Introduction to Islam
Islam and Women's Rights
Diversity, Equity & Inclusion Program
Islam and Other Faith Traditions
"Daughters of Abraham" Event
Afghanistan Crisis and/or Helping Afghan Refugees
Topics related to Gaza/Palestine and Israel
Other:
Required
Name and Description of Event
*
Your answer
Date
*
Your answer
Time
*
Your answer
Location
*
Your answer
Type of Audience
Your answer
Number of expected attendees
*
Your answer
Length of Speaking Engagement
*
Your answer
Honorarium Amount Offered
Note: Aneelah's honorarium is anywhere from $500-$5,000, although she works with organizational budgets and does speak without an honorarium in certain cases too
Your answer
Please provide any additional information you would like us to consider
Please note that submitting a speaker request form does not guarantee approval. All speaker requests will be confirmed or declined by e-mail after review.
Your answer
Thank you for your request. You should hear back from us directly, but feel free to email
amen@mapsredmond.org
to follow up. With gratitude and good wishes.
Your answer
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