Client Program Preparation Form

Client Program Preparation Form

Name of organization: ______

phone #:______fax #:______

contact______title:______

address:______

city/state/zip______

are you familiar with (insert company/speaker name)?______

seen/heard______where?______

______

type of meeting:______

session type: keynote/seminar/workshop/consultation/custom training

time of presentation:______to ______fee: ______

presentation date: ______

type of program: ______

sales/marketing/accounting/spouse/eduation/etc.

purpose for the meeting: ______

education/obstacles/problems/goals/etc..

number of expected attenders: ______last year/month:______

program theme: ______

location: ______

what do you want to accomplish:______

______

who was the speaker at your last meeting: ______

how was he/she received: ______

what could participants be doing better that would improve performance and

productivity: ______

______

how do you want people to feel when they leave the meeting: ______

______

are these general or concurrent sessions: ______

other speakers: ______

______

major problems/concerns(insert company/speaker name) could address: ______

what would precede (insert company/speaker name):______

what will follow (insert company/speaker name): ______

topic: ______

speech title: ______

who supplies evaluations: ______how are materials handled: ______

room set-up: ______

u/classroom/rounds/theater/other

equipment needed: ______

flip chart/overhead w/screen/vcr wlmonitor/microphone/l6mm projector/slide projector/etc.

what are you looking for in your speaker for this event: ______

______

skill development/motivation/inspiration/humor/ind spec/etc.

what professional speakers have you utilized: ______

what are your budgetary restrictions? ______fees? ______plus expenses:______

who in your organization is well known and liked by the people in attendance:

name:______

phone:______

buz words within your organization: ______

PRE-PROGRAM QUESTIONNAIRE

This questionnaire is designed to assist us in preparing a customized program for your organization. Please answer all applicable questions as thoroughly as possible and return to us at the above address no later than ______with the items requested on number 18.

1.Name of organization ______

2.Date of presentation ______

3. Composition of audience ______

4.Number expected to attend ______

5.Length of presentation ______

6.What is the theme of the meeting? ______

______

1. What are the specific objectives/results desired from our program? ______

______

1. What is the mission/philosophy statement of your organization? ______

______

9.What are some of the current problems/ challenges/breakthroughs experienced by your industry? ______

______

______

1. Are there any sensitive issues or terms to avoid? ______

______

11. Meeting Time: Begin______End______

12. Meeting Location: Site ______

Address ______

Distance from Airport to Hotel ______Distance from Hotel to Site ______

Recommended Mode of Transportation from Airport to Hotel ______

Recommended Mode of Transportation from Hotel to Meeting Site ______

13.What takes place immediately before/after our program (meal, break, etc., if smother speaker, please indicate topic)?

Before ______

After ______

(Please note: I like to arrive an hour early to each program to view the room and set up as well as personally introduce myself to attendees as they arrive.)

14.If problems/emergencies arise on the way to the program, whom should we contact? Name ______

Business Telephone # ______Home telephone #______

15.Name and telephone number of general manager, employees, and/or associates we can contact to get additional information:

Name ______Telephone # ______

Name ______Telephone # ______

Name ______Telephone # ______

1. Previous consultants and/or programs used:

Name ______

Program ______

Name ______

Program ______

17.Name and telephone number of people you would like to refer to

Name ______Telephone # ______

Name ______Telephone # ______

Name ______Telephone # ______

18. Please send us the following information (if available):

______Meeting agenda/information

____Company newsletter/paper/flyer

____Special promotions/campaigns