Pre-Program Questionnaire

This questionnaire is designed to help us prepare the best possible customized presentation. 

Please return to us no later than_____________________. Thank you!

Name of Group:____________________ Date of Presentation:______________

Person completing this form:_________________ Phone: (____)_____________

Fax #: (_____)_________________________ Email address:_______________

WWW address if any:______________________________________________

Meeting Time: Begin___________ End___________
My Program:  Begin___________ End___________
2nd program:  Begin__________End__________

Meeting Location:________________
Address: ______________________
City:__________________________

Hotel Address:_________________Phone#:_________________Fax#_______

Closest Airport:___________________ # miles from site___________________

Would you prefer that I dress: In a suit & tie?________Business Casual________Casual?_________Other?___________

Approximate Number attending meeting:______ f______(%) m______(%) Age range:___________

General job responsibilities of attendees:___________________________________________________ ___________________________________________________________
___________________________________________________________
 

If this presentation is part of a conference, what is the theme, if any?________________________________________________________

What is the mission/philosophy statement for your company/organization?
____________________________________________________________
____________________________________________________________

What are some problems / breakthroughs / challenges currently experienced by
your company or industry?
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________

What changes have taken place in your organization / industry in the last few
years? _______________________________________________________
____________________________________________________________
____________________________________________________________
_____________________________________________

What changes do you anticipate in your organization / industry in the near
future?
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________


What are the top challenges faced by people who will be in the audience?
____________________________________________________________
____________________________________________________________
 

If there is a special program or project you are currently conducting within
your organization or department, please briefly describe its name, nature,
and any accompanying slogans: ___________________________________
____________________________________________________________
____________________________________________________________

What is unique about your group? (i.e.: seasonal work flow, special clientele,
unusual hours, travel, red-tape, communications...)
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________

What phrases/sayings do executives frequently use?___________________
____________________________________________________________

Please list any in-house or marketing specific language, jargon, phrases, or
words applicable to your group that might be incorporated into this
presentation:

______________________________________________________________
______________________________________________________________

Is there anything of significance that this group can be proud of
accomplishing as a group?
______________________________________________________________
______________________________________________________________

Specifically, what "local color" should I use in my presentation? This could
be anything, such as a new company policy, an in-house buzzword, a local
drinking place, poor food, and a broken piece of equipment, local weather, or
achievement of a top official in your organization.
_____________________________________________________________
_____________________________________________________________

Overall objectives of meeting or conference:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________

Specific objectives for Mike's talk:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
 

Any seeds you would like Mike to Plant:
_____________________________________________________________

Top People to recognize in the audience or people to poke "fun" at:
Name: ________________________________ Title:____________________ Reason:_____________

Name:________________________________ Title:____________________ Reason:_____________

Please list the names of two accomplished professionals within the group
that Mike could call to get additional perspective.

Name:________________________________ Title:___________________ Phone #:____________

Name:________________________________

Title:___________________ Phone #:____________

Schedule - What's happening before & after
talk?_________________________________________________________
_____________________________________________________________

Will there be other speakers?______Topics:___________________________
_____________________________________________________________

Please list past speakers:__________________________________________

Introducer - (name & title):________________________________________

Is is possible for one or two guests to sit in on Mike's program?______________

May Mike offer his books and tapes for sale following his program?________ He will never "hard sell."

Note: Please send a copy of all memos, program announcements, brochures, and other promotional materials relating to this presentation so our presentation will be consistent with your promotion. In addition, any annual reports, a company newsletter/paper/flyer, or any key product brochures would be appreciated, if available.

Thank you very much for helping us customize our presentation for your group!