Speaking Engagement Request for

Craig and/or Marc Kielburger and Roxanne Joyal

REQUESTED SPEAKER:

COMPANY/ASSOCIATION
Company/Association/ School Name:
Contact Name:
Title:
Street Address:

City:
Province/State:
Postal/ZIP Code:
Country:

Tel:
Cellphone:
Fax:
E-mail:
Website:

LOCATION/MEETING SITE
Facility Name:
Facility Street Address:

City:
Province/State:
Postal/ZIP Code:
Country:

Facility Phone:
Presentation Room

GENERAL INFORMATION
Date of Presentation:
Type of Event:
	If other:
Start Time of Presentation:
End Time of Presentation:
Keynote Address Only Keynote Address & Workshop
Objective of Meeting:
Theme:
Please provide background information on your event:
Appropriate attire:

AUDIENCE INFORMATION
Audience Size:
Age Range:
% Male vs. % Female:
Industry:
	If other:
Description of attendees :
	If other:
Please provide any other information that you think may be important for us to know:


ROOM SETUP
Seating Arrangements:

AV REQUIREMENTS
- LCD Projector
- White Screen, size suitable to the size of the room and audience
- Cord to connect laptop to sound system
- Marc: lapel mic; Craig: wireless hand-held mic

HONORARIUM
Please note that the honorarium goes towards supporting Free The Children's international development projects

ADDITIONAL EXPENSES
Additional expenses include air and ground transportation; accomodations; and meals. These expenses will be estimated and mutually agreed upon.

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