PRE-PROGRAM Qtjestionnaire

Name of Client or Group:
Date of Program:
Program Topic:

This questionnaire is designed to help us prepare a program that is specifically tailored to the needs of your group. Please take a moment to answer all the questions as completely as possible and feel free to skip those which would duplicate a previous answer or which might be irrelevant to your group, or that have been discussed with Lenora already. Then return the form to our office NO LATER THAN FOUR WEEKS BEFORE THE ENGAGEMENT. If you need additional space, please feel free to add a page or write on the back.

Please include whatever printed information you feel would help Lenora understand your organization’s people, products, services and industry. Lenora would rather have too much information than too little. Printed (including digital) information could include:

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· Meeting specific – agenda required; promotional brochures

· Newsletter – internal & external

· Advertising, product literature & other promotional materials

· Current articles about your industry

· Newspaper or magazine articles about your organization

· Trade publications

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Logo: Please email a company or program theme logo for use on the customized handouts and slides to .

The purpose of this questionnaire is not to create additional work for you, but to significantly increase the value of the program for your people. Thank you!

How to Complete this Form

1. Fill out this form on your computer

a. Email it as an attachment to

b. Complete it by hand

c. Mail it to the address below

Lenora Billings-Harris, CSP

PO Box 1628

Greensboro, NC 27402

Client Contact Information
Contact Information for the primary person Lenora should contact for any aspect of this program:

Name: / Address:
Title: / Phone:
Company: / Cell Phone:
Email: / Website:

In case of emergency the day or evening before the event, who should Lenora call?

Name:
Cell Phone:

Logistics

Meeting Information (If not in the hotel where Lenora will stay)
Location Address:
Phone: / () / Other:
Meeting Room:
Airport Information
Closest Airport / Airport Code:
Distance from meeting location in drive time:
Will someone be meeting Lenora at the airport? / Yes / No
Who:
Where:
If no one is meeting Lenora at the airport, what is the best way to get to the hotel? / Taxi / Limo / Other (explain)
Lenora’s Hotel Information (If the meeting is being held at hotel, Lenora’s room should be master billed. If not, please recommend a Marriott property close by and our office will book the room.)
Hotel Name:
Address:
Phone: / () / Fax: / ()
Confirmation #:
Distance from meeting location in miles: / in minutes:
Lodging Requirements:
· Please reserve a king bed, non-smoking room for the night prior to the event.
· Guarantee for late arrival.
· Direct bill room and tax to master account.
· Lenora usually arrives the night prior to her presentation and will depart after her presentation.
· We will email you her itinerary prior to the meeting.

The Meeting

Start Time: / End Time:
Lenora’s Start Time: / Lenora’s End Time:
Meeting Attire: / Business Casual Business Semi-Formal Formal / Other
What happens before and after Lenora’s talk (i.e. speaker, workshop, break, meal etc…)? (or attach agenda with this information)
Before:
After:
Are there any other speakers on the program? If so, please identify them by name, title and topics they will discuss:
Name / Title / Topic
Who will introduce Lenora? / Name: / Title:
Phone: / () / Email:
Meeting Theme:
Specific purpose of the meeting:
Top 3 objectives for Lenora’s presentation: / 1.
2.
3.
Key or sensitive issues to avoid (if any):
Are there any messages that you would like Lenora to reinforce?
Are there any issues/topics in particular that you think I should discuss during the program?
Have you any other suggestions to help us make this program your best ever?
Audience Analysis
Number of attendees: / Female % / Male %
Average age ranges(Check the majority group): £ 25 26-35 36-45 46-55 ³56
Spouses invited: / Yes No
General description of audience:
Major responsibilities of audience members, and typical job titles?
What are the names/titles of your key people (leadership)?
Name: / Title / Yrs with Co/Org
Employees are referred to as: employees team members associates / Other
What areas of the attendees overall working performance are ripest for improvement?
What are the top three challenges faced by the people who will be in my audience?
1.
2.
3.
What other information should Lenora know about the audience?
When your people depart from this presentation, what ONE thing do you want to be uppermost in their minds?

The Organization

What is your company’s diversity mission statement? (list the website link if easier)
What is the overall focus or mission of the organization for the year?
What is your organization most proud of?
What are your company/organization colors?
Do you have any key phrases you often use?
What do you consider the primary strengths of your organization/people?
What are your primary products and/or services?
Who are your customers by type? ( B to B; consumers, etc.
Who are your major competitors by name and product category?
Who is your primary competitor from the above list?
Name an industry or association periodical that is important to your group:
.
What are some current problems/fears/frustrations experienced by your industry or organization?
What are the most significant events to have occurred in your industry/organization/group during the past year (i.e. expansion, relocations, reduction in workforce, new laws, etc...)?
Do you have any corporate “heroes” (other organizations or leaders admired, studied or referenced by your managers)?
Please share with me any "industry color" (i.e. promotions, unusual regulations or policies, Murphy's Law in action etc…):
Have audience members experienced any diversity and inclusion training? If so, list titles of examples offered by the organization.
What is unique about your group?
Using only 3-4 adjectives, please describe the kind of speaker who has been a big hit with this group:
Adjective 1 / Adjective 3
Adjective 2 / Adjective 4
How will you know if Lenora was a hit?
What speakers have you had in the past?

Resources

Web Links / Please feel free to create links from your website to ours if you’d like to introduce your group to Lenora prior to her presentation. Some useful links Include:
Home Page – www.UbuntuGlobal.com
Preview Video – http://vimeo.com/74926519
Articles by Lenora – http://www.ubuntuglobal.com/resources/
Social Media / Please right click on the icons and choose “open link” to include Lenora’s social media sites in your promotions:

E-zine / Lenora publishes a weekly called The Diversity Advantage Weekly. Check it out at http://thediversityadvantage.info
To subscribe your group, simply send a list of email addresses to the attention of Molly at . Subscriptions are free and you can unsubscribe at any time. We adhere to a strict privacy policy. Individual subscribers can go to http://www.ubuntuglobal.com/newsletter/ to sign-up.

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