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Pre-Program Questionnaire
Contact Information
Organization or Association:
Your Full Name:
Your E-mail:
Your Position:
Your Phone:
The Presentation
Presentation Title:
Start Time:
Event Date:
End Time :
What is on the Program before I speak?
What happens on the program right after I speak?
Conference Title and Theme:
Purpose of the Meeting (e.g. annual meeting, awards banquet):
Specific Objectives of my presentation:
Sensitive Issues to be avoided:
Who are the other professional speakers on the program?
Speaker:
Topic:
Speaker:
Topic:
Speaker:
Topic:
What speakers have you used in the past that covered topics related to the materials I will present?
What did you like? Dislike? Withhold their names if you prefer, but please comment on the material they presented:
Please share any "local color" you may know related to the location where the event will be held:
What comments or suggestions do you have that will help me make this presentation captivate your audience?
The Audience
How many people do you expect:
Percentage Male/Female:
Average Age:
Educational background:
Age Range:
Major Challenges
Major Problems:
Major Job responsibilities of Audience:
Will there be any "special guests?" Please explain:
What is the groups overall opinion regarding the subject of my presentations:
Please provide the name and phone numbers of several people who will be in the audience so I can contact them
for additional group information and suggestions so I can better customize this program.
Travel Information
Event Location:
Airport to Arrive at:
Address:
Ground
Transportation:
Phone:
If an emergency occurs on the way to the site, who would be an alternate contact if you are unavailable:
Name:
Business Phone:
Cell Phone:
Enter Security Code:
Thank you for taking the time to provide this information. I will use it to prepare an outstanding presentation for the group.
