This survey is designed to help customize a program for you. The more complete the information, the better. Just answer those questions that pertain to your particular session. Please submit the form no later than three weeks prior to the event. Thank you so very much. Please print or type. Feel free to add any additional pages you think are necessary.
Your Name: _______________________________________________________
Phone Number: (_____) _________________________
Fax Number: (_____) ________________________
Web Site: _______________________________________________________
General Background Information
1. Please describe the mission of your organization.
2. What is your organization’s major strength? What makes your organization unique? If applicable, what is your organization’s competitive edge?
3. If applicable, who are your major competitors? Who are the industry leaders?
4. What are some of the current problems or challenges experienced by your industry/organization/people?
5. What are the most significant events to have occurred in your industry, group or organization during the past year? (mergers, relocations, cutbacks, new product or service, legislation, etc.)
1. What are your specific objectives for my session? In other words, what three things would you like the audience to walk away with?
2. Are there any issues/topics in particular that you think I should discuss during my program? Key issues to avoid (if any)? Are there any subjects, words, phrases or concepts that people are negative about, that should be avoided?
3. Is there a theme or slogan you want “planted” as a seed for the group?
4. Language: Please list some in-house or market-specific jargon, phrases, acronyms or other words that might be appropriate for incorporation.
5. Program Mix: How much?: ____% motivation ____% how-to/nuts-and-bolts
1. How many people will be in the audience? __________ Can you be more specific as to the % breakdown of the audience (males/females, rank within the profession or company, level of sophistication, average age, ranges of age, etc.):
2. Are there any language or literacy barriers? If so, what percentage?
3. Will attendees be co-workers, leader/follower, or a mixture? Are they acquainted with each other? Any potential problems, competitive factors, peer pressure, or other dynamics that I should know about?
4. Would you describe the group as:
5. For fun: Is there a “personality” in the group? Either a role model, or someone with a habit that he/she is known for in a congenial type of manner? Are there any “in jokes?”
6. For recognition: What is happening right? Any individuals or departments, work groups, etc., which might be cited for credit, etc. within the context of this presentation?
7. Can you provide a “day-in-the-life-of” example who best represents this audience? Or, can you give me the names and phone numbers of other people whom I might contact?
1. What did they like about speakers they’ve heard in the past? What did they not like? Why did you select me?
2. How will this program be advertised and participants recruited? Voluntary or mandatory attendance?
3. Any “hot” books in the industry?
Checklist of Resource Material
Please also send any information (annual reports, newsletters, etc.) which will provide a better understanding of your organization, its product and its people. All promotional materials, memos, etc. related to this presentation would also be very helpful.
__ Annual report
If possible, please furnish me with the logo, nameplate or program theme in a format suitable for reproduction on a handout.
Final thought – What did I not ask that you think I should know?
or Fax to: