09.22.17 | Request A Speaker JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.Request A SpeakerThank you for your interest in learning more about our work to protect African refugees and immigrants in the United States. Please complete this form, and a member of our staff will contact you to discuss your request and our ability to accommodate it, which may vary depending on staff availability and capacity.Sign in to Google to save your progress. Learn more* Indicates required questionFirst Name *Your answerLast Name *Your answerEmail Address *Your answerPhone Number *Your answerOrganization *Your answerType of organization *LegalSocialEthnic groupMeeting groupMedicalCollegeUniversityHigh SchoolReligiousOthersStreet Address *Your answerCity *Your answerStates *Your answerZipcode *Your answerIssues/Topics of Interest *Your answerAttendance *10 - 2020 - 3030 - 5050 - 100100 and aboveWhat is the audience for your fundraiser, training, or event? *ProfesionalsCommunityVolunteersYouthStudentsParentsOthersRequiredPlease describe your fundraiser, training, or event. *Your answerPlease tell us more about what you hope to accomplish at your fundraiser, training, or event. *Your answerIn which city will your fundraiser, training, or event be held?Your answerVenue Address *Your answerEvent City *Your answerEvent State *Your answerEvent Zipcode *Your answerEvent Date *MM / DD / YYYYEvent TimeTime:AMPMEvent Duration *Your answerSubmitClear formNever submit passwords through Google Forms.This form was created inside of African Law Center, Inc.. Does this form look suspicious? Report Forms