Pre-Event Questionaire

Organization/Association name:  
Meeting Planner/Contact name:  
Title:  
E-mail:  
Mailing address:  
City:  
State:  
ZIP:  
Phone:   EXT:
Fax:  
Mobile Phone:  
Web site:  
     
     
LOCATION OF MEETING    
Date(s) for Mark's program:  
Presentation start time:   a.m. p.m.
Duration:  
What happens just before Mark speaks?  
What happens just after Mark speaks?  
Facility:  
Phone number:  
Event Room:  
Address:  
City:  
State:  
ZIP:  
Onsite Contact:  
Appropriate attire for Mark:  
Who will introduce Mark?  
Title:  
Phone:  
Email:  
     
     
Room Requirements: Non-smoking. Please make a reservation at a hotel that is convenient to your event and confirm for late arrival.
     
Lodging will be direct billed to master account:   Yes No
Meals will be direct billed to master account:   Yes No
Lodging same as presentation location:
(if “yes” skip below)
  Yes No
Hotel name:  
Address:  
Phone:  
Confirmation #:  
     
 
TRAVEL INFORMATION
Mark will make his own travel arrangements and provide you with a copy of his itinerary prior to your event. Travel arrangements will be made only after receiving this completed form.
What airport is closest to the program site?  
What other airport (if any) should be considered?  
Number of miles from airport to hotel:  
Number of miles from hotel to venue:  
Ground transportation: Mark will use a cab or rental car unless other arrangements have been made in advance.
     
ROOM SETUP    
How will the room be arranged for Mark’s presentation?   Rounds Theater Other
     
     
Please refer to the Audio Spec sheet provided. Unless other arrangements have been made, please provide the name of an audio contact person. Mark will need to give them a call to discuss details.
Name:  
Phone number:  
Cell phone:  
Company:  
Fax number:  
Email:  
Time that room will be empty and available for sound check.   a.m. p.m.
Program title you have selected:   Take the Leap
Getting and Staying Focused
The Courage for Change
Will Mark's presentation be audio or video taped?   Yes No
     
     
This section is optional, but it will assist Mark in tailoring his program for your group.
What is Mark's role in the event?
(Opening or Closing Keynote, Luncheon Speaker, Breakout Session etc.)
 
What other speakers will be presenting at this event?  
What is the purpose of your event?  
What is the purpose of Mark's presentation?  
What would cause you to say
"WOW...that's just what I wanted to happen!
 
What is the theme of your event?  
How does this theme relate to the outcomes you hope to achieve from this event?
 
How many will be attending the overall event?  
How many will be attending Mark’s presentation?   Total Number
% Women
% Men
Age Range of Attendees
Will spouses be attending?   Yes No
Who will be attending (job titles and job responsibilities)?  
What separates your high-performing people from the others?  
What is the biggest challenge or fear facing your people?  
What are some recent victories?  
Who was the previous speaker for this group last year?  
What was their topic?  
     
AGENDA    
Please email info@allaboutteamwork.com or fax (907)770-9000 a complete agenda of your conference/event.
     
BEST TIME TO CONTACT    
When would it be convenient for Mark to talk with you (via phone) about his presentation?
Date:  
Time of Day:  
This form was completed by:  
Date completed: