Success By Choice
Pre-Program Customization Questionnaire
Contact Information
Name of Company / School / Organization
Contact Name
Title
What is your role in planning this event?
decision maker
committee member
event planner
other
Address
City
State
Zip
Phone Number
Fax Number
E-mail Address
Program Details:
Preferred Speaking Date
Event Name
Presentation Start Time
Desired Length of Program
Address of Event Location
Closest Airport and Distance to Event Location
Pre-Program Customization:
What are your specific objectives / results desired for this program?
What percentage (%) "How to" / Nuts and Bolts Information?
What percentage (%) Motivational / Inspirational?
What are the demographics of the audience (size of group, position of attendees, background,
special interests, etc.)?
What will the participants be interested in learning from this session?
What are the top three challenges faced by the people who will be in the audience?
Is there any special terminology to use in the presentation?
Are there any special issues/terms to not be included in the presentation?
Are there any key people in the audience to be recognized?
Is there a program theme?
How did you become aware of Success By Choice?
Additional Comments
