Take More Action! - Tour Request Form

Thank you for your interest in Leaders Today’s speaking tour! Please fill in the fields below and press submit. Once your date is approved, we will contact you at our earliest convenience to finalize your booking.

* denotes a mandatory field

*PLEASE LIST THREE DATES YOU ARE INTERESTED IN
Each date should fall on a separate week
1st Choice:
2nd Choice:
3rd Choice:
*HOST INFORMATION
Contact name
School
Street Address
City/Province/State
Postal/Zip Code
Phone
Cell phone
Fax
Email
*WHO IS FILLING OUT THE FORM
 
*Group Type
 
LOCATION OF PRESENTATION IF DIFFERENT THAN ABOVE
Facility name
Street Address
City/Province/State
Postal/Zip Code
Phone
Presentation room
On site contact name
On site contact phone
On site contact cell phone
On site contact fax
On site contact email
On site contact emergency phone
AUDIENCE INFORMATION FOR KEYNOTE
Number of student participants
Number of teacher participants
Grade(s)
Age range of students
Male/female ratio of audience
GENERAL INFORMATION
Interested in:
Note: * plus GST 		Keynote address only
Sample Schedule

8:30 AM – 9:15 AM        Tech Check

9:30 AM – 10:30 AM      Keynote Address

10:45 AM – 11:45 PM    Workshop (1 hour)

11:45 AM – 12:45 PM    Lunch

12:45 PM – 2:45 PM      Workshop (2 hours)
Does this sample schedule work for your school?
Note: Workshop is 2-3 hours in length and accommodates up to 20 participants
Audio and visual requirements for keynote presentation
  • Two microphones
  • LCD projector
  • White screen for projected images - size suitable to auditorium and audience size
  • Amplification for projected video from laptop with volume suitable for audience size
  • Cord to hook sound to laptop
Room set up for keynote presentation
  • Theatre style
Requirements for workshop
  • Whiteboard with markers and eraser
  • Flip chart with markers
Requirements for workshop
  • Room large enough for participants to engage in interactive activities
  • Should ideally be able to accommodate double the number of participants
  • Chairs for all participants and two facilitators arranged in a semi-circle
  • All tables moved to the walls or moved aside to allow space for activities
  • Weather permitting, interactive activities may be conducted outdoors on school property
RECORDING
Will the presentation be video or audio taped?
Please tell us why you want to record the presentation
Please note that recording the presentation requires consent from Leaders Today or Free The Children
MEDIA
Are you inviting Media?
Would you like our speakers to be available for interviews?
TRAVEL AND ACCOMMODATION
If you are not in the Toronto area, please take a moment to fill out these fields.
*Air  
Nearest airport to speaking engagement facility is
Distance from airport to facility is
*Accommodation (if applicable):
Please provide us with 2 hotel recommendations that are close to your school/facility.
Past Involvement
Please describe past involvement with Free The Children or Leaders Today  
Please describe any other involvement, past involvement with other social awareness organizations or campaigns.  
Working hard to make this tour as affordable as possible
We are pleased to let you know that we will cover the cost of travel, accommodation and meals when we are able to confirm three or more presentations in your area. Please contact us so that we can work with you to make the tour come to your region.
**Is your booking contingent on this offer?  Yes No