Success Unleashed-Debra Pestrak

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This questionnaire is designed to help prepare a program that is specifically tailored to meet the needs of your group. Please take a moment to fully answer all the applicable questions. At the end is a “Send” button to submit your answers. Thank you.

Special request: Please send me as much information as possible to help increase my understanding of your organization. This includes association magazines, news releases, newsletters, or other information you feel would be of value. Thank you.

 a. Number of attendees?
Spouses invited?
 b. Number of males?
 c. Average age of group?
 Age ranges? From to
 d. Major job responsibilities of audience members?
 e. What are the names/titles of your top people who will be at the meeting?

 a. What is your specific objective for my session?
 b. Are there any issues/topics in particular that you think I should discuss during the program?
 c. Key issues to avoid (if any):
 d. Name and title of my introducer:
 e. Starting time for: My program
Entire program
 f. Ending time for: My program
Entire program
 g. What takes place before my program (speaker, meal, workshop)?
 h. What takes place immediately after my program (break/another speaker/nothing, and so on)?
 i. If other speakers are on the program with me, who are they and what are their topics?
 j. City/Hotel/Meeting Room?
 k. Have you any other suggestions to help us make this program your best ever?


 a. What do you consider the primary strengths of your organization/people?
 b. What are some current problems experienced by your industry/organization/people?
 c. What areas of their overall working performance are ripest for improvement?
 d. What are the most significant events that have occurred in your industry/organization/group during the past year (i.e., expansion, relocations, reduction in force, new laws, and so on)?
 e. What are the top three challenges faced by the people who will be in my audience?
 f. Please share with me any “industry color” (i.e., promotions, unusual regulations or policies, Murphy’s Law in action, and so on)
 g. When your people depart from this presentation, what ONE thing do you want to be uppermost in their minds?

4. Contact Information:

Company name
Your name
Mailing address

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