Pre-Program Questionnaire

Pre-Program Questionnaire

By filling out the questionnaire, Van will be able to tailor his presentation to the specific needs of your group. Please type your response nto the blanks below the questions and then click on the SUBMIT button. This will automatically email the document to my staff at the TopLine Factor. Please answer the questions as completely as possible and as quickly as possible. If we have already discussed any of the information requested below, feel free to skip the question. Van strives to deliver a home run experience every time and this information below will assist Van in making that happen.

Contact Info

* Completed by:

Cell Phone In Case of Emergency:

How did you hear about Van?

Why did you hire Van?

The Meeting

* Name of the Company:

* Name of Event:

Overall Objective/Goal:

Other Speakers in Attendance-Please include their names and topics:

Logistics

Closest Airport and Estimated time from Airport to Meeting Location:

Will someone meet Van at airport or should he use sedan service?

Meeting Location:

Street Address:

Telephone:

Specific Location of Van’s presentation? Room? Floor?

Van’s Hotel Name(If information same as above please skip over):

Address:

Phone:

Will you be serving Breakfast and/or Lunch?

Van likes to arrive approximately 30 minutes before presentation. Who will meet him in the meeting room?

How well will participants know each other?

Are spouses invited to event? Yes
No

Can you provide a brief description of the audience?

What are their responsibilities?

What are the titles of those in attendance?

What are their challenges? What keeps them up at night?

What do participants know about Van’s topic? New to Topic
Intermediate
Advanced

How does your audience react to interaction? Very Interactive
Moderate
No Interaction

Are there any sensitive issues I should avoid?

My Program

Meeting Start time and End Time:

Introducer-Name, Title, Cell Phone Number:

What will happen before and after Van’s Presentation?

Why did you choose Van’s topic?

What are the three objectives for Van’s Presentation?

If you were delivering the presentation, what message would you like communicated with your audience?

Your Organization

What is your website?

What is the mission and philosophy statement of your organization?

What are some of your organization’s major accomplishments?

Primary Products or Service:

Biggest Challenges your organization faces:

* Verify

Script by Dagon Design

Pre-Program Questionnaire

Contact Info

The Meeting

Logistics

My Program

Your Organization

Tip #4