FOR PROGRAM:_____________________________________ Date_______________________

Please take a moment to answer all applicable questions and return to our office NO LATER THAN________________.

1. What is the specific purpose/theme of this meeting? (annual meeting/awards, etc.)
2. What are your specific objectives/results desired from my session?
3. If I could wave a magic wand and help your group do one thing better in your business, what would it be? What keeps you up at night?
4. Is there good news/bad news about your organization that I should/should not include in the presentation?  Significant humorous event/s that have occurred in your organization/industry during the last year? Mistakes that have occurred we can now laugh about?
5. Special jargon or terminology used in your industry? Key issues or terms to avoid? (if any)
6. Size of organization:   Lg. corporation   Mid-size  100-500   less than 100
   # of Attendees______ Avg. Age______ %Male______ %Female______
   ____%board of directors ____%senior exec. ____% Mid-mgmt.
   ____%sales reps ____%support/clerical ____%entrepreneurs ____%spouse
7. People to recognize in audience:

Name_______________________________Title______________________________

Reason_______________________________________________________________

Name_______________________________Title______________________________

Reason_______________________________________________________________

Could you possibly obtain a sample of handwriting from these people?

Perhaps they could fax you a quick memo. Note: It is advantageous to have a sentence or two in addition to the signature. It is important that any person profiled be well known to the group, as well as enjoy the attention.

8. What takes place immediately before/after my program? (speaker, meal, break)

If there will be another speaker, please indicate topic:

Before________________________________________________________________

After_________________________________________________________________

9. Name of my introducer: ____________________________________ Title:________________________________

Tel( )________________________
Fax()_______________________e-mail:_____________________

10. Will the session be
audio taped?   Video taped?  
Whom should I contact to obtain a copy of the tape?_______________________________________________

Tel( )______________________________
Fax( )_____________________________

11. Please send the following information if possible:

• strategic plan/objectives 
• key product brochures
• annual report/history
• industry magazine
• special promotions/campaigns
• company newsletter/paper/flyer
• meeting agenda/invitation
• other____________________________

12. Lecture Topic_________________________________________

Day______________________ Date______________________ Time______________________

13. General Information

Meeting Planner ____________________________________Phone________________________

Fax ______________________e-mail:___________________________

Organization__________________________________________________________

Company_____________________________________________________________

Address__________________________________P.O.Box__________________

City__________________________________State_________Zip____________

14. Logistics

Meeting Location: ___________________________________________________________________

Address_________________________________________City_________________

Closest airport________________________________

Transportation from the airport to site/hotel? Cab_________ Limo_________ Other_____________________

If someone is meeting me, please provide: Name_________________________________________________

Tel#______________________________________Pager#___________________________

15. You Need From Me:
(Please check material you need.)

• Introduction
• Bio
• B&W photo
• Press kit
• Demo Video
• Audience handout master

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