Leadership Takeout Order Form

Group Information

LEAD Fellows can work with your class, student organization, or group to develop an adventure based workshop that fits the needs of your class, group, or student organization and deliver it to your desired location. Please complete the form below, include as much detail as you can, and a LEAD Fellow will get in touch with you to schedule a consultation meeting to determine the best approach for your program.  

Preferred Date*
Please allow at minimum three weeks of planning and preparation between your request and the date of your preferred program date.  This allows the LEAD Fellows the appropriate amount of time to properly plan for your program request.  


Alternative Date:
Anticipated time of day for your program.
Group Name

Primary Contact for the Group*
Who it the best person for a LEAD Fellow to follow up with regarding this request?

Primary Contact Phone Number
Primary Contact Email Address
Type of Group

About the Group*
Tell us a little bit about the group.

Anticipated number of participants at program

Are there any accommodations the LEAD Fellows not to be aware of concerning participants in this program?