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Media Inquiry Form
"
*
" indicates required fields
1
Interviewer Information
2
Interview Information
Media Organization
*
Name of Interviewer
*
First
Last
Title
Phone
*
Email
*
Enter Email
Confirm Email
Date Requested
*
MM slash DD slash YYYY
Time
*
Hours
:
Minutes
AM
PM
AM/PM
Estimated Length
*
Alternative Date
*
MM slash DD slash YYYY
Scope of the interview with sample questions
*
Type
*
TV
Print
Radio
Online
TV Channel
Print Outlet
Radio Channel
URL
Language of Audience
*
Publishing date
*
MM slash DD slash YYYY
"I have read and agree to the terms and conditions set forth by Dar al Hijrah Islamic Center when conducting interviews or other media-related activities on the premises of Dar al Hijrah Islamic Center."
*
I agree
For Etiquette of visiting a Mosque (Masjid) : https://hijrah.org/media/etiquette-of-visiting-a-mosque-masjid/
