Full Name of the Requester (*) Email of the Requester (*) Work Number/ Cell Number of Requester (*) Please Select Type of organization (*) ---EducationalFaith BasedHealth CareLaw EnforcementOther If selected "Other", please provide Information Name of the organization/group that ING Midwest would be presenting to (*) Number of expected audience members (*) Type of audience (*) ---AdultsHigh SchoolMiddle SchoolOther Preferred presentation start time ---07:00 AM07:30 AM08:00 AM08:30 AM09:00 AM09:30 AM10:00 AM10:30 AM11:00 AM11:30 AM12:00 PM12:30 PM01:00 PM01:30 PM02:00 PM02:30 PM03:00 PM03:30 PM04:00 PM04:30 PM05:00 PM05:30 PM06:00 PM06:30 PM07:00 PM07:30 PM08:00 PM08:30 PM09:00 PM09:30 PM10:00 PM10:30 PMOther Presentation time length (*) ---30 MINS60 MINS90 MINS120 MINSOther Requested date of presentation (*) Select the presentation you are interested in (*) Getting to Know American Muslims and Their FaithA History of Muslims in AmericaIslamophobia and Its ImpactsMuslim Contributions to CivilizationMuslim Women Beyond the StereotypesOther In case you selected "Other", please indicate the title or subject of the presentation Address where the presentation would take place (*) State (*) City (*) Would you be able to provide a presentation projector for our laptop (*) ---YESNO If so, what type of port does the projector have? VGA port, HDMI port, or both (*) ---HDMIVGABOTH (HDMI, VGA)I don't know
