Dear Event Organizer(s):

Thank you for requesting Mukhtar Muhammad be a part of your program. We are honored to receive your request.

As an author, national commentator, civic, business and community leader, Mukhtar Muhammad is a recognized consultant on topics as diverse as strategic planning, internal community development, governance, operating documents review, process design and systems management to business development. He is available as keynote speaker, panelist, or moderator and also has significant experience leading workshops and seminars.

Please complete the following request form and expect a reply normally within 24-48 hours.

Organization Name
Location (City/State)
Event Dates(s)
Enter date as dd/mm/yyyy
Event Time(s)
Target Audience
Expected Number of Persons Attending
Describe what you are requesting of Mukhtar, e.g. Consulting, Training, etc.
Total Event Presentations Requested
Provide brief history of event, e.g. annually held, purpose, previous speakers, past attendance:
Description of your organization, e.g. for profit, when established, size of membership, etc.
Organization Phone Number: *
Organization Website
Your Name and Title*
Your Telephone Number:
Your Email
Best time to contact you:
What is/are the goals for this event?
If you are publicizing event in your local media, should I expect interviews?
Additional Comments

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