NCCM – National Council of Canadian Muslims | NCCM Workshop / Leadership Bootcamp Request

Name of Requesting Organization:*

Name*

First Last

Address*

City Province

Work Phone*

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Email*

Choose Your Workshop*

Suggested Date of Workshop*

Time of Workshop*

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Location of Workshop*

City Province

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The Expected Audience:*

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Is this workshop part of a larger event/conference*

If yes, Provide details on Program Segments and Speakers:

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NCCM Workshop / Leadership Bootcamp Request