Please note: all fields marked with an asterisk (*) are required.
Program High School Climate Challenge HSBC Clean Air Achievers Air Aware General CAC presentation (FEE) How did you hear about Clean Air Champions? Choose ---------- Website Email Event Media Facebook Twitter Word of mouth Other Event dates
Please list at least one desired date and time for the Champion's visit, starting with your top preference as #1.
Who will be the main contact person for this booking?
Where will the event take place?
Please provide specific details about the audience, your school/organization and the context of the Champion's visit, which may be relevant for the Champion to adapt his/her message to the specific situation. The more details you include, the better!
Will media be present? Yes No Maybe Specific environmental interests of the audience or organization: Other information you feel may be relevant (i.e. school enviro themes or top sports, wheelchair access, socio-economic issues of student body etc):
Will the following be available for the Champion's presentation?
VHS or DVD player and television or projector Yes No Maybe Laptop and projector Yes No Maybe Table or area for display of sport paraphernalia Yes No Maybe PowerPoint software Yes No Maybe Internet access Yes No Maybe
For all CAC booking requests that are not part of our school programs (i.e. HSBC Clean Air Achievers, High School Climate Challenge & Air Aware) there is a fee to book a Champion. The balance of this fee is applied to administration, shipping, phone and other expenses directly related to ensuring our Champions are well prepared for their presentations.
Please indicate if you can cover a fee in this range ($300-$600): Yes No Maybe
If you selected NO or MAYBE, please describe your situation below. Within 48 hours of submitting this booking request, a member from our CAC staff will contact you to discuss possible options.
With regards to for-profit organizations and corporate requests, please describe your event and the role you would like our Champion to play. The more detail you can provide the better:
We try and match our Champions to events that are within close proximity to their homes, place of work or sport training so that they can maximize their active transportation options. However, we also realize that this is not always possible or practical for the Champion or the client and we will accommodate accordingly.
After each Champion's presentation we ask the contact person, or someone who has witnessed the entire presentation, to complete a short survey to evaluate the performance. The survey will be sent by e-mail to the contact person indicated in this booking form. Please complete this survey within days after of the Champion's visit.
We look forward to working with you to make your event a success. If you have any questions please feel free to contact Clean Air Champions' staff at firstname.lastname@example.org.