You and Your Company / Organization Name of Company / Organization: Number of Employees / Members: Background information on Your Company / Organization: (Mission or mandate, size, area represented, connections to other organizations) Contact Person Name: Contact Person Phone: *Contact Person Email:: Your Event Date of Event: JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 12345678910111213141516171819202122232425262728293031 20032004200520062007200820092010 Nature of Event: Breakfast Meeting Luncheon Meeting Dinner Meeting Conference Other Expected Audience Size: Who will greet and introduce the speaker? Event Venue: Venue Address: Venue Contact Info: Requested Presentation Length of Requested Presentation (including Questions & Answers): 20 Minutes 30 Minutes 1 Hour 2 Hours Desired Focus of Presentation: (Key Message / Issue for Your Audience) Role and Mandate of the CMLTO Quality Assurance and the MLT CMLTO's Complaint & Discipline Program Professional Accountability Other: Can you provide any of the following A/V equipment? (Please select more than one if appropriate.) Screen Laptop LCD Projector For large presentations, either a Podium with Microphone or a Lapel Microphone is required. Can these be provided? Yes No Would you like an information display? Yes No Would you like us to provide hand-out materials? Yes No
Your Event Date of Event: JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 12345678910111213141516171819202122232425262728293031 20032004200520062007200820092010 Nature of Event: Breakfast Meeting Luncheon Meeting Dinner Meeting Conference Other Expected Audience Size: Who will greet and introduce the speaker? Event Venue: Venue Address: Venue Contact Info: Requested Presentation Length of Requested Presentation (including Questions & Answers): 20 Minutes 30 Minutes 1 Hour 2 Hours Desired Focus of Presentation: (Key Message / Issue for Your Audience) Role and Mandate of the CMLTO Quality Assurance and the MLT CMLTO's Complaint & Discipline Program Professional Accountability Other: Can you provide any of the following A/V equipment? (Please select more than one if appropriate.) Screen Laptop LCD Projector For large presentations, either a Podium with Microphone or a Lapel Microphone is required. Can these be provided? Yes No Would you like an information display? Yes No Would you like us to provide hand-out materials? Yes No
Requested Presentation Length of Requested Presentation (including Questions & Answers): 20 Minutes 30 Minutes 1 Hour 2 Hours Desired Focus of Presentation: (Key Message / Issue for Your Audience) Role and Mandate of the CMLTO Quality Assurance and the MLT CMLTO's Complaint & Discipline Program Professional Accountability Other: Can you provide any of the following A/V equipment? (Please select more than one if appropriate.) Screen Laptop LCD Projector For large presentations, either a Podium with Microphone or a Lapel Microphone is required. Can these be provided? Yes No Would you like an information display? Yes No Would you like us to provide hand-out materials? Yes No
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