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Please take a few minutes to complete this form so we can create a customized presentation for your organization. Please call us at 770-860-9464 if you have any questions. We are looking forward to working with you in the near future.

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Items in blue are required.

Organization
Event Date
Your Name
Your E-mail Address
Your Phone

Have you established a theme or purpose for your meeting?

Would you like me to conduct a survey of your members prior to the program? Let's talk No Yes
What are the 2 or 3 major challenges faced by the people who will be attending our program?
1.
2.
3.
What top three issues or ideas I can address you would like to see improve?
1.
2.
3.
How would you describe the anticipated audience? (fun loving, serious, participative, reserved etc.) People expected to attend:
Average age: Range of ages: to
Educational background(s):


Is their attendance at your meeting mandatory? Yes No
What should I know about the people in your group before I start my program? Are there any problems, competition, resentment or peer pressure that I should know about?

When you think about using an outside speaker, what are your reservations?

What interesting or significant events have occurred within your industry or to your group during the past year?
Please describe how change is impacting on the people in your organization.

How would you like the audience to feel when they leave my session?

What are your primary objectives for this meeting?

What are your primary objectives for my presentation?

What should be the mix of "content" and humor/entertainment?
% content % humor/entertainment
Are there any particular issues or topics I should address during my program?

Are there any sensitive issues that I should avoid?

What other speakers have spoken to this audience in the past?

Are there websites I should visit to learn more about your organization/industry?

Do you have any other suggestions to help us make this program more successful?

Please provide the name and title of my introducer and how I can contact him/her:

Please provide me with 3-5 names, phone numbers and/or email addresses of audience members so I can speak to them as part of my research. It would be helpful if they hear from you ahead of time to let them know I might be contacting them.

Occasionally, meetings get off schedule. If this happens before my presentation, would you prefer that I (please select one)
Speak for the allotted time
Finish at the appointed time.
If you are pleased with my services, would you mind writing a letter of recommendation for my files? Yes No
Click submit to send your completed survey form.

Please send us also any printed material (newsletters, brochures, annual reports) on your group or your industry. This will help us to customize the presentation.

Thank you very much for taking the time to complete this survey form.

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