Speaker Request Form

We’re ready to help you find the speaker for your event. Many speakers are available for a variety of presentations, including key note address, panel, seminar and classroom discussion, workshop facilitation, media appearances, or even training & development. Our speakers address diverse audiences from government agencies and corporations, to business, civic conferences and religious forums.

Use the form below to conveniently submit your request preferably three weeks or more prior to your scheduled event. Usually within 48 hours, CWSC will connect you with a speaker. Note: CWSC does not arrange or assume liability for speaker engagements. All arrangements are made between the requesting organization and the speaker. Prior to completing the form, the submitting organization representative or contact is required to read Hosting Organization Information.

For questions, please email info@cwsc.us or call (910) 317-0297.

First Name

Last Name

Your Organizational Title

Phone

Organization Name

Organization Website

City

State

Date(s) requested

Time (including time zone)

Full Meeting Site Address (including room no.)

Parking Instructions

Budget for Speaker

Type(s) of Presentation (Check all that apply)

Keynote Speaker

Panelist

Moderator

Media Interviews

Seminar Leader

Workshop Facilitator

Entertainer (Comedian, Musician or Other Performing Artist)

Desired Presentation Topic or Theme

If you selected "Other," then list topic and other comments here

Enter Primary Reason for Event (e.g., annual fundraiser)

What are the goals for the Event?

Number of Attendees

Describe Target Audience

Enter here explanatory or additional comments

How did you hear about the CWSC Speakers Bureau?

Thank you for completing your request. We’ll be in touch shortly!

Visit our broadcasting network too, American Muslim 360!

Together we can remake the world

Speaker Request Form

Like this:

Speaker Request Form

Share this:

Like this: