Pre Program Survey

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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Name*
First Last
Email*
Subject:
Phone
Event Date
MM slash DD slash YYYY
What is the theme or purpose for your meeting?
Would you like me to conduct a survey of your members prior to the program?
- Yes
- No
- Let's talk about it
What are the 2 or 3 major challenges faced by the people who will be attending the program?
What top issues/objectives you would like me to address in my presentation?
How would you describe the anticipated audience? (fun loving, serious, participative, reserved etc.)
Number of people expected to attend
Average age
Age Range
Educational background(s)
What should I know about the people in your group before I start my program? Are there any particular issues or problems that I should know about?
Please describe how the affects of change is impacting on the people in your organization.
What interesting or significant events have occurred within your industry or to your group during the past few years?
How would you like the audience to feel when they leave my session?
What should be the mix of "content" and "humor/motivation"?
% Content
% Humor/Motivation
Are there any particular topics I should address during my program?
Are there any sensitive issues that I should avoid?
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 key individuals I should speak to 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
Name
This field is for validation purposes and should be left unchanged.

Please send us any printed material (newsletters, agenda, 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.

Pre Program Survey

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