Email:

Name & Title:

Organization:

Phone Number (including country code):

Presentation Time Preference:

(please note these times are EST)

This years conference is entitled; "We Are The People of Science: The Revival of Islamic Medicine in the 21st Century" .  Please choose a topic for your presentation relevant to the event title and your line of work.  Please give us an idea about what you would like to speak on. 

(Please note: what you submit today is not final.  Speakers have until April 1st, 2022 to finalize their presentation title/topic).

In exchange for your agreement to speak at our 1st Annual Conference, we would like offer you a free honorary lifetime professional membership to our academy or you can choose to participate in our advertising program.

Advertising Program -   Advertising packages include a 1:30 min commercial which will be played during intermissions at the conference.  All commercials will be produced by our marketing team here at HNPA and will be delivered to you after the conference, in shaa Allah.

Please make your selection below:

Speaker Registration Finalization:

I agree to participate as a speaker on the dates/times selected in this form.