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Event Title: |
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Organization: |
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Event Date: |
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Event Time: |
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Attire: |
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Mona is looking forward to visiting your group. She would
like you to help her make her appearance more successful by taking a few
minutes to fill out this questionnaire. This will significantly increase
the value of her program by allowing her to deliver a more personal
message of customized content.
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The Program
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1. What is the conference/meeting
theme?
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2. Presentation title selected for
Mona?
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3. What is the specific purpose of
this meeting?
(Annual event, Awards Banquet, etc., and which year?)
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4. What are your specific objectives for this event?
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A.
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B.
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C.
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5. Are there any special
issues/topics you would like addressed to help
make the presentation your best ever?
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6. Issues to avoid, if any:
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7. What takes place immediately before and after Mona's presentation?
(lunch, another speaker, etc.)?
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Would you like a written
introduction? |
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Yes
No |
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8. Are there any functions preceding Mona's presentation
that her
presence could enhance?
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9. Time of Mona's presentation:
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Start:
End:
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10. Are you planning to audio and/or video tape the presentation? |
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Audio
Video |
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What will the tapes be used for?
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(Please remember, you must receive
written permission from us to do so.) |
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Are you requesting permission now?
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Or, have you already done so?
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11. Are there other speakers on
the program? |
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Speaker [1]
(Title) |
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Topic
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Speaker [2]
(Title) |
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Topic
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12. Which speakers have you used
in the past for a similar event?
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13. With your permission, we would
like three contact persons Mona may
personally speak to in order to gain more insight
for her presentation: |
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Name
Title |
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Phone (W)
Phone (H)
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Name
Title |
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Phone (W)
Phone (H)
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Name
Title |
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Phone (W)
Phone (H)
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Audience Information
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1. Number of attendees?
Are spouses invited?Yes
No |
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Percent
male/female?
/
Age range?
to
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Percentage of the audience who are managers or supervisors?
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Income
range?
to
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Educational Background?
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Ethnic make-up?
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2. Who will be attending this
event?
(executives, managers, employees, clients,
community, etc)
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3. What are the major job
responsibilities of those in the audience?
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4. What areas of their overall
working performance are ripest for improvement?
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5. What separates your high performance personnel from the others?
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6. What are the names and titles of your top executives who will be at
the meeting?
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Name
Title |
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Name
Title |
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Name
Title |
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7.
Is there anything else Mona should know about the audience before
addressing them?
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8. State three major points you want emphasized:
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A.
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B.
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C.
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9. If you could cause those in
attendance to do one thing
as a result of this presentation, what would it be?
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General Background Information
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1. What is the purpose/mission of
your organization?
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2. What are your organization's
goals?
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3. What are 1 or 2 things your
organization is most proud of?
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4. Is there a concern shared by
the audience and, if so, what is it?
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5. What is the greatest challenge
they are currently facing?
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6. What are the most significant
events that have occurred in your industry,
organization or group during the past year?
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7. Please share any "industry
color." (i.e. Did a major firm go bankrupt, etc)
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8. What funny things are used as
common "in house" humor?
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9. What would you like the
audience to walk away from this event with
they didn't have when they arrived?
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10. Would you like for us to know
anything else?
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In addition, please forward any other
information regarding your organization and
this event (brochure, annual
report, agenda, literature, promotional materials, etc.) |
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Additional Information
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1. Contact person at the event?
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Phone (C)
Phone (H)
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E-mail
Website
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2. If there is an emergency during traveling, who should be contacted:
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Name
Title |
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Phone (1):
Phone (2):
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Phone (3):
Pager:
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Emergency Back-up Information
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3. Event location
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Event Phone:
Fax:
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Event Room:
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Distance from hotel:
Distance from airport:
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4. Audio/visual requirements
confirmed: Mona requests a cordless clip-on microphone,
overhead or LCD Projector and a 10x10 Screen. Have
arrangements been made?
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Yes
No |
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5. Hotel where speaker will be staying (if different from above)
(When room is prepaid, please remember
to include meals)
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Hotel Phone:
Fax:
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Distance from airport:
Confirmation #:
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6. Person picking up and returning
Mona to airport:
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Company:
Name:
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Phone:
Cell/Pager:
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Will driver be at:
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Baggage
Claim
Curbside
Gate |
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