Engagement Request

Thank you for your interest in engaging with the Initiative on Islam and Medicine (II&M) for your upcoming event or program. Our esteemed team of scholars, researchers, and experts is available to offer workshops, lectures, educational programs, and consulting services at the intersection of Islamic tradition and contemporary healthcare.
Please complete the form below to submit your request. Requests should be submitted at least six (6) months in advance for consideration. Upon submission, you will receive a confirmation email. For inquiries or to expedite your request, contact us at contact@medicineandislam.org. We will follow up within two weeks to discuss your request and identify the appropriate speaker or expert for your event.

For any speeches that are given, videos in MP4 format must be sent to us within 8 weeks of the event date.
We thank you for taking the time to reach out to us and look forward to partnering with you!

Date:

Contact Person (Name):

Email Address:

Phone Number:

Name of Organization:

Type Of Engagement:

Name of Event:

Date of Event:

Start Time:

Length Requested:

Location of Event (Please include exact location or indicate as “Virtual.”):

Suggested Title / Speaking Topic:

Are there any other speakers?

Yes No

II&M workshops are $5000 inclusive of honorarium.

Is there an honorarium?

Yes No

Amount (USD):

Will the inviting organization or institution be covering expenses for housing, air, ground travel and subsistence-related expenses?

Yes No

Is there a fee for the workshop or consulting services?

Yes No

Amount (USD):

Domestic US Travel: Economy tickets with economy plus seats
International Travel: Premium economy or business class for flights longer than 3 hours
Housing: 3-star hotel or above. If this is not available, a good quality university guest house or bed and breakfast facility may be doable.
Ground Travel Expenses (Uber, Lyft, Taxi, etc.): Host to cover expenses.
Subsistence expenses (meals, refreshments, etc.): Host to cover expenses.

Additional Notes/Comments/Concerns we should be aware of when considering your request.