Welcome to KENTUCKY ISLAMIC RESOURCE GROUP (KYIRG)

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• Current Affairs
• School Program to
Prevent Hate

To request a speaker, please complete the following form and submit to KYIRG. In most cases, you will receive a call-back within 24 hours.

1.	Your Name:
2.	Organization/School:
3.	Email Address :
4.	Address:
5.	City, State, Zip Code:	, ,
6.	Work Phone:	( ) - Ext.
7.	Home Phone (preffered for teachers):	( ) -
8.	Best Time to Call :
9.	Desired Outcome ( describe what you would hope the audience would receive from the speaker ):
10.	Optional Dates you would like speaker to present:
11.	No. of periods Requiring a Speaker (teachers only):
12.	Start and End Times of Periods Requiring a Speaker (please be as accurate as possible for proper scheduling):	: to :
		: to :
		: to :
		: to :
		: to :
		: to :
		: to :
13.	Additional Comments:

If you would like more information about us, please write to us, call us or email us.

Kentucky Islamic Resource Group
P.O. Box 911142
Lexington, KY 40591
Telephone: (859) 219-0703
Email: speakers@kyirg.org