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? ______
______
- What are the specific objectives/results desired from our program? ______
______
- What is the mission/philosophy statement of your organization? ______
______
9.What are some of the current problems/ challenges/breakthroughs experienced by your industry? ______
______
______
- 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 # ______
- 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