Pre-Program Questionnaire

The Program
What is your conference/program theme?
Specific presentation title requested
What kind of meeting is it? (annual meeting, awards banquet, training session, etc.)
Who is responsible for calling this meeting? (hr, sales, operations, etc.?)
Specific objectives for Chuck’s presentation?
Which company executives, if any, will be speaking before Chuck Gallagher?
What happens on the program right after Chuck speaks?
Date
MM slash DD slash YYYY
Start Time
: Hours
Minutes
AM/PM
End Time
: Hours
Minutes
AM/PM
Introducer's name
Introducer's title
Who spoke at your meeting last year?
What would make Chuck’s presentation really "special" for your group?
Sensitive issues that should be avoided?

Name the key executives that will be in Chuck’s audience. With your permission, we would like to contact them for more research on your group.
Name
Phone
Name
Phone
Name
Phone
Name
Phone
What three main things should Chuck know about your group?
Is there any jargon that Chuck should be familiar with (acronyms or titles)?
On which target markets/industries does your organization primarily focus?
Who is your typical customer (e.g.: C.F.O., VP Sales, Individual consumer, internal employees)?
If Chuck could leave your group with two thoughts what would they be?

Logistical Information
Introducer's name
Introducer's title
Is there any publicity work that Chuck can do for you while he is at your event? Please let us know in advance so that travel can be arranged.
Will the presentation be taped?
- Yes
- No
Audio taping?
- Yes
- No
Video taping?
- Yes
- No
What is the nearest major airport to the meeting site?
Distance to the meeting site from the airport (miles)

Exactly where is the meeting?
Hotel
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Fax
How will Chuck be transported from the airport to the hotel?
If picked up, company/contact name
Phone
Confirmation #

Emergency Contacts
Name
Title
Business phone
Pager
Cell Phone
Title
Business phone
Home phone
Pager
Cell phone
Any additional comments or information that would be helpful in tailoring this presentation for your group?

General Information