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No! We’re not inquiring about your aches & pains, we want to know what problems you and your organization are facing.

Keep this sheet close at hand and jot down the challenges you encounter on a daily basis… and I’ll address as many of them as possible in my presentation.

I want to know. I want to help. Please fill out this form and send it to me.


 

PRE-PROGRAM QUESTIONNAIRE

When you complete this questionnaire you enable Sam Geist to learn more about your business and your audience. By taking a few moments to answer all the questions, you contribute to a presentation suited to your group.
Thank you for your assistance.

Fill out the online form and you're finished!


When you complete this questionnaire you enable Sam Geist to learn more about your business and your audience. By taking a few moments to answer all the questions, you contribute to a presentation suited to your group.
Thank you for your assistance!

Date of Event (DD/MM/YY):

Name of Organization or Meeting:

A. Purpose Of The Program

1. What type of meeting is it?

Annual Conference Other

What is your specific objective for the overall meeting?


What is the theme of your conference or meeting?


How was it chosen?


Why was it chosen?

2. What is Sam Geist's role at the meeting?
    Opening keynote Closing keynote Luncheon speaker
    Other

3. What are your specific objectives for Sam Geist's session (i.e., what would you like the audience to walk away with)?
A.
B.
C.

4. What changes do you want your audience to make as a result of Sam Geist's presentation?
A.
B.
C.

5. What speakers has your audience heard in the past?
Name Topic
Name Topic
Name Topic

6. What have you appreciated about speakers you have heard in the past?
  

7. What have you disliked about speakers you have heard in the past?
  

8. What sensitive issues, if any, should be avoided in this presentation?
  

B. About Your Industry & Organization

9. What major products and/or services does your organization provide?
   

10. What clients or customers do you serve?
   

11. Who are your major competitors or threats?
   

12. What major changes or challenges face your industry and organization?
   

13. What successes or breakthroughs has your organization had recently?
   

14. Please describe the culture of your organization or association.
   

15. How many employees/members does your organization have?

C. About Your Audience

16. How many people will be attending Sam Geist's presentation?

17. What is the percentage of men & women in the audience?
     Men Women

18. Will spouses be attending? Yes No

19. What is the average age of the audience? Age range?

20. The majority of the audience will have years of experience in the industry?

21. What are the major responsibilities of audience members?

22. To which group should Sam Geist primarily direct attention?

23. What is the educational background of your audience?

24. Where will the audience come from geographically?

25. Who are the other professional speakers, company executives, or industry experts on the program?
Name Topic
Name Topic
Name Topic

26. Please indicate anyone in your organization you wish Sam Geist to contact to contact for more information to customize his program.

Name:
Title:
Organization:
City,State:
Phone:
Fax:

Name:
Title:
Organization:
City,State:
Phone:
Fax:

D. Logistics & Schedule

29. What takes place immediately before Sam Geist program?

30. Starting time: Sam Geist's program
                                   Entire program

31. Ending time: Sam Geist's program
                                  Entire program

32. What takes place immediately after Sam Geist's program?

33. Person introducing Sam Geist?
Name:
Phone:

34. How will the meeting room be set up?

35. Person responsible for room set up?
Name:
Phone:

36. Person responsible for a/v set up?
Name:
Phone:

37. When will the meeting room be available for an A/V check?
Date:
Time:

E. Participant Handouts

Sam Geist will provide a handout for your participants. The master of the document will be sent to you for duplication and distribution at the event.

38. Where should we send the handout master?

Name:
Organization:
Address:
City:
State:
Zip:
Phone:
Fax:

F. Travel Information

39. Where will the event be held?

Location:
Address:
City:
State:
Zip:
Phone:
Fax:
Meeting Room:

40. Nearest major airport to arrive at?
Distance to the meeting site in terms of miles?
time?

41. Where will Sam Geist stay?

Hotel:
Address:
City:
State:
Zip:
Phone:
Fax:

Who will make the reservation?
Meeting planner
Sam Geist's office Reservation
confirmation number:
Reservation must be made by (date, if applicable, DD/MM/YY)

42. In case of an emergency, who should Sam Geist contact?

Name:
Business Phone:
Home Phone:
Cellular Phone:
Pager:

43. This form completed by:

Name:
Title:
Company:
Address:
City:
State:
Zip:
Phone:
Fax:
E-mail:
Web site:

G. Research Documents Requested

To get more in touch with your audience, Sam Geist would appreciate any information to better know your industry, association or organization. Please send all the following which are available:

  • Mission, Vision, Values, Philosophy Statement
  • Annual Report p 2-3 Recent Newsletters p 2-3 Trade Journals or Magazines
  • Outlines or scripts of senior executives' speeches (when appropriate)
  • Service or Product Brochures -- Advertisements
  • Recent Press Clippings or Articles Written About Your Company
  • Employee Handbook or Orientation Package
  • Program materials; event or conference agenda
  • Letters From Customers or Suppliers
  • Relevant Memos or Reports
  • Video Tapes or Video Newsletters

Thank You For Taking The Time To Complete This Questionnaire!