Booking Details

Please choose an MS Ambassador for me based on what is most appropriate for my event.

Do you need to book more than one ambassador?

YesNo

Please provide the names of the ambassadors you wish to book

Which ambassador would you like to book?

If your selected ambassador is not available, we will advise you and make a recommendation of an alternate speaker. This sometimes occurs due to travel constraints (i.e. ambassadors can be located in regional or remote areas).

Date & Time

Is the ambassador required for more than one day?

YesNo

Describe the days and times the ambassador is required

(e.g. "24 May 2016 from 10am to 2pm, and on the 25 May 2016 from 11am...")

When is the ambassador needed?

Date:

From:

To:

About Your Event

Name of your event

(e.g. L&L MS Awareness Fundraiser)

What MS fundraising event is this for?

Describe your event

(What started the idea to run this event? What activities or workshops are planned? Who else is speaking? Is there anything special about the venue? Why should people attend?)

Presentation purpose and desired outcome

(How will an MS Ambassador enhance the event? What do you think people will get out of the presentation?)

Roughly, how long would you like the ambassador to present for?

3-5 mins10-20 mins30-40 mins1 hourOther

How many people will attend the presentation?

Less than 1010-2020-5050-100More than 100

Is the audience mostly male or female?

Mostly femaleRoughly evenMostly male

Roughly, what will be the average age of audience members?

Less than 2021-3031-4041-50Over 50

Is there anything else you'd like to tell us about your event?

(e.g. "the venue is tentatively booked at the moment, it may change")

Do you have any files related to the event you can provide us with?

(e.g. agenda, flyer, brochure, etc)

What equipment is available at the presentation venue?

MicrophonePodiumProjector

Describe available parking at the venue

(e.g. parking available at centre, paid car park next door, on-street 2P parking, etc)

Is disabled access available at the venue?

YesNoNot sure

Venue Address

The event will take place at my office address

Venue name

Street no.

(inc. suite no.)

Street name

Suburb

Postcode

State

(ACT, VIC, NSW, & TAS only)

Your Details

Are you an MS Limited staff member?

YesNo

Title

(e.g. Mr, Ms, etc)

First name

Surname

Position / job title

Email address

Mobile no.

(optional, but recommended)

Organisation Details

Name of your organisation

Company website

Office phone no.

Mailing address

Street no.

(inc. suite no.)

Street name

Suburb

Postcode

State

(ACT, VIC, NSW, & TAS only)

Contact Information