Your Name:


Your Email Address:


In case of emergency I should call:

Name:

Day/Night phone:

Special Request: Please send as much information as possible to help increase our understanding of your organization. This includes association magazines, news releases, newsletters, annual reports and other information you feel would be of value, ESPECIALLY YOUR WEB SITE ADDRESS.

Interviews: Please send the names, titles, phone numbers and e-mail addresses of three people who will be attending the conference, and who are representative of the total group. I would like to chat with each of them for approximately 15 minutes to gain insights.

What is the overall focus or mission of the business for the year?

I. Audience Information:

a. Number of attendees?

b. Number of Males: c. Number of Females

e. Average Age of group f. Range of Ages

g. Major responsibilities of audience members, and typical job titles?

h. What are the names/titles of your key people?

1. Name: Title:

2. Name: Title:

3. Name: Title:

II. The Program Itself:

a. The theme is:

b. What is your specific objective for my session?

c. Are there any issues/topics in particular that you think I should discuss during the program?

d. Key issues to avoid (if any).

e. Name, title, phone number and e-mail of my introducer:

Name: Title:

Phone: Email:

f. Starting time for my program

g. Starting time of entire program

h. Ending time for my program

i. Ending time for entire program

j. What takes place before my program (speaker, meal, workshop)?

k. What takes place immediately after my program (break/anotherspeaker/nothing)?

l. If other speakers are on the program with me, who are they and what are their topics:

Speaker 1:
Topics:

Speaker 2:
Topics:

Speaker 3:
Topics:

m. Name of: City/Hotel/Confirmation number/Meeting Room?

City:

Hotel:

Confirmation number:

Meeting Room:

n. Have you any other suggestions to help us make this program your best ever?

III. General Background Information:

a. What do you consider the primary strengths of your organization/people?

b. What are some current problems experienced by your industry/ororganization/people?

c. What areas of their overall working performance are ripest for improvement?

d. 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.)

e. What are the top three challenges faced by the people who will be in my audience?

Challenge 1:

Challenge 2:

Challenge 3:

f. Please share with me any "industry color" (i.e. promotions unusual regulations or policies Murphy's Law in action etc.)

g. When your people depart from this presentation what ONE thing do you want to be uppermost in their minds?

h. Any other comments you would like to add: