1. What is the "theme" (mission) for this program?

   
   
   

2. What are the top three challenges facing your people you want addressed during his presentation? (What keeps you up at night? If you had three wishes what would they be? What are they worrying about?)

   
   

3. Please list the names, phone numbers, and e-mail addresses of three people to call to tailor the program:

   Name
   Work Phone
   E-mail

    

   Name
   Work Phone
   E-mail

    

   Name
   Work Phone
   E-mail

   
   Attendee Profile #4 through 9 (approximately)
   
   

4. Estimated number of attendees:   
   

5. Is attendance required?

   Yes No
   

6. What is the anticipated age range or the attendees?

   Teens Twenties Thirties Forties Fifties and above
   

7. Percentage of Males?      
   

8. Percentage of Females?   
   

9. What will be the normal education level of the participants?

   Please select None HIgh School or Equivalent Some College College Graduate School or other higher education
   

10. What else should Patrick know about your people before presenting his program? (Items to include or avoid - for example: key issues, "buzz words," jokes . . .)

    
    

11. What specifically would you like the participants to be able to do differently or do better after the program? (Outcomes and/or results you want participants to achieve)

    
    

12. What kind of training have participants had in the past on this topic?

    
    

13. What did the audience like or dislike about the presenter?

    
    

14. To what trade, business or professional groups does your organization belong?

    
    

15. What publications does your organization subscribe to or read?

    
    

16. What is your organization's website address (if applicable)

    
    

17. What can Patrick do to make this program your best program ever?

    
    

18. Please provide the contact information of the decision maker or meeting planner:
    

    Name
    Title
    Organization
    Work Phone
    FAX
    E-mail

THANK YOU!