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?________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 Nancy 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 Nancy 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 Nancy's program?______________
May Nancy 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!
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?________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 Nancy 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 Nancy 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 Nancy's program?______________
May Nancy 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!
