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 Dress?________Business Casual________Casual?_________Other?___________

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

General job responsibilities of attendees:___________________
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If this presentation is part of a conference, what is the theme, if any?________________________________________________________

What is the mission/philosophy statement for your company/organization?
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What are some problems / breakthroughs / challenges currently experienced by your company or industry?
____________________________________________________________
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What changes have taken place in your organization / industry in the last fewyears? _______________________________________________________
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What changes do you anticipate in your organization / industry in the near future?
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What are the top challenges faced by people who will be in the audience?
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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: ___________________________________
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What is unique about your group? (i.e.: seasonal work flow, special clientele, unusual hours, travel, red-tape, communications...)
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What phrases/sayings do executives frequently use?___________________
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Please list any in-house or marketing specific language, jargon, phrases, or words applicable to your group that might be incorporated into this
presentation:

______________________________________________________________
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Is there anything of significance that this group can be proud of
accomplishing as a group?
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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.
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Overall objectives of meeting or conference:
_____________________________________________________________
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Specific objectives for Nancy’s talk:
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Any seeds you would like Nancy to Plant:
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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 Nancy could call to get additional perspective.

Name:________________________________ Title:___________________ Phone #:____________

Name:________________________________

Title:___________________ Phone #:____________

Schedule - What's happening before & after
talk?_________________________________________________________
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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 Nancy’s program?______________

May Nan cy offer her books and tapes for sale following his program?________ She 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!