Name of Sponsoring Organization

Address

City

State

Zip

Conference Logistics

Meeting Location

Meeting Location Address

Meeting Location City

Meeting Location State

Meeting Location Zip

Nearest Airport

Approximate Miles From Hotel or Site

Method of Transportation to and from the Airport

Hotel Information (if different from event site above, include name, address and phone).

Tell Us More...

Number of Attendees

Age Range

Percentage Male

Percentage Female

General Job Responsibilities of Attendees

What is the theme for your event?

What is the mission/philosophy statement for your company/organization?

Website

What changes do you anticipate in your organization/industry in the near future?

If there is a special program or project you are currently conducting within your organization or department, please briefly describe its name, nature and any accompanying slogans.

What is unique about your group? (i.e. seasonal work flow, special clientele, unusual hours, travel, etc.) Is there anything of significance that this group can be proud of accomplishing?

Please list any in-house or marketing specific language, jargon, phrases, or words applicable to your group that might be incorporated into this presentation.

Specifically, what “local color” might be used in this presentation? This could be anything, such as a new company policy, an in-house buzzword, a local drinking place, poor food, a broken piece of equipment, local weather or achievement of a top official in your organization.

Overall objectives of meeting or conference?

What would make this session a 10 for YOU and this group? How will you know I hit the target?*

Any seeds you would like me to plant?

Is there anything I haven't asked that you think I should know about your organization that would make this program more meaningful?

Key People To Recognize In The Audience Or Get Further Input From

First Person Name

First Person Title

First Person Phone

Second Person Name

Second Person Title

Second Person Phone

Program Schedule

What time(s) exactly will I be speaking?

What's happening before and after my presentation?

Are there any special events going on around the time of my presentation that you would like me to take part in?

Contact Information

Primary Contact Name*

Daytime Phone*

Cell Phone*

Primary Contact Email*

Best Time to Reach

AV Contact Person

AV Phone Number

AV Check Time

Deadlines

Are there deadlines that we need to be aware of to help your job go more smoothly? (ex: handouts, CEU forms...)

Miscellaneous

Will there be other speakers and if so who?

What other topics will be covered?

Please list past speakers

Introducer Name and Title

How did you hear about me?

Would you be interested in pre-purchasing any books or products for your group at a quantity discount? (Call for price quote.)

Are product sales permissible/appropriate? If so, how would you like me to handle the purchase of products?