Flyer Request Form
Requestor Information
Full Name
*
First Name
Last Name
Phone Number
*
Email
*
Committee Name
*
Deadline for Flyer Completion (Must be at least 7 days from today)
*
-
Month
-
Day
Year
Flyer Details
Logo
*
e.g. ICN, ICNY
Title
*
Subtitle
Optional
Contact Email
Optional
Text/Content
*
Please provide all the text/content you want on the flyer.
Footer Text/Content:
Optional
Form Details
Do you require a registration or payment form for this flyer?
*
Yes
No
No, I already have a form.
Form Link
Form Details
Event Information (Optional)
Is this a one-time event or will it be on a recurring basis?
Once
Recurring
Event Start Date/Time
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Event End Date/Time
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Recurring Schedule
Select Event Location
Olesen (Masjid Al-Hidayah)
Ogden (Masjid Al-Hilal)
75th
248th (Masjid An-Noor)
Noor Academy
Not Applicable
Other
Other Event Location
Street Address Line 1
Street Address Line 2
City
Select State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Comments (Optional)
Additional Comments/Special Instructions
Submit
Should be Empty: