Request for Muslim Chaplain Services for Hospitals/Prisons/Correction Facilities


Educational Presentation - Please arrange an educational presentation at our Hospitals/Prisons/Correction Facilities for us.Request for a Visit by a Muslim Chaplain at our Hospitals/Prisons/Correction Facilities for us

Provide Details for the Request (e.g. your background? Reason for requesting presentation/inter-faith dialogue? Proposed title of lecture/time/schedule/complete address of your location etc.)


ORDER DETAILS

My faith is:

if selected other above, please specify:

Comments (e.g. your background? Reason exploring Islam? Comments about our services etc.)

First Name

Last Name

Address:

if selected other above, please specify:

Your Email:

Your Phone: