Information for Connie Merritt's Presentation
The answers to this questionnaire are vital to help Connie prepare a program
specifically suited to the needs of your group. Please be willing to invest this time. As
soon as we receive it, Connie will contact you to fine-tune the program to your needs and
objectives.
Please return this to our office ASAP to insure your program's success.
Print out this form, fill out the form, and fax or mail to this address :
P.O. Box 9075, Laguna Beach, CA 92652-9075
FAX: 949-494-3009
OR
Copy and paste into Word Document, fill out, attach to an email to:
OR
Copy & paste directly into email to:
Information for Connie Merritt's Presentation
on _______________(date)
for___________________________________
(exact name of organization)
Name of person completing this form:__________________
The answers to this questionnaire are vital to help Connie prepare a program specifically suited to the needs of your group. Please be willing to invest this time. As soon as we receive it, Connie will contact you to fine-tune the program to your needs and objectives.
What is the mission statement or philosophy of your organization? (Send any pertinent materials)
What kind of meeting is this? (annual, awards, retreat, etc.)
What is the theme of this meeting?
Connie's Program
What is your chosen title for Connie's program?
What are your specific objectives for the program?
1.
2.
3.
4.
Are these the same objectives and title printed in the program? YES NO
When Connie is done and the audience is walking out the door; what are the two things you want them to be saying?
When Connie’s program is completed, how will you determine the value to the meeting & attendees?
What takes place immediately before Connie's program? (other program, break, meal)
Starting time for Connie's program: Ending time:
What takes place immediately after Connie's program? (other program, break, meal)
Other speakers and their topics/titles?
Meeting room location:
Connie's introducer:
Name:
Phone:
Fax:
Email:
Audio/visual contact:
Name:
Phone:
Fax:
Email:
Audience Background
Number in audience: Spouses invited? Average age:
Percentage Male/Female: Educational background:
Job titles and/or responsibilities of those attending?
What are their major challenges and/or most frustrating issues?
What are they doing RIGHT?
What specific areas of work performance are ripest for improvement?
What points do you want the attendees to retain?
Are there any sensitive issues or topics to be AVOIDED?
Who are their hero's and experts?
Who are their major competitors?
Anything else that will help Connie understand the audience better?
Key individuals to contact by phone for insider's viewpoint prior to program (please provide a good cross-sampling of the audience
Name:
Title:
Phone:
Fax:
Email:
Name:
Title:
Phone:
Fax:
Email:
Name:
Title:
Phone:
Fax:
Email:
Name:
Title:
Phone:
Fax:
Email:
Industry/Organization Insights
Who are the officers/top management in your organization? (name, title, phone, email)
1.
2.
3.
4.
What issues in the organization keep them awake at night?
What are some current problems experienced by your industry and/or organization?
What is the "State of the Industry" or industry summary?
What are the most significant events that have occurred in your industry/organization during the past year?
Please share any "industry color."
What funny things are used as common "in house" jokes?
What are the best books written about your industry?
Emergency Contact: if Connie encounters any problems on the way to the program
Name:
Phone:
Cell Phone:
Home Phone:
Travel details
Closest or most convenient airport:
Distance miles:
Time to travel:
Best way to hotel/meeting site: (taxi, hotel shuttle, rental car)
( I have included map to hotel and meeting site, if rental car is necessary)
Hotel:
Address:
City, State, Zip
Phone:
Fax:
Key Contact:
Have you reserved a sleeping room (non-smoking, non-connecting, away from elevators/stairs/vending/ice) and guaranteed for late arrival?
YES Reservation/confirmation #_________________________
Connie wants to be at her best for your event, therefore she prefers to have a light dinner from room service and retire early. If there is a scheduled function the evening before, please contact us.
Other pertinent materials included
Organization magazine and/or newsletter Annual report
Meeting flyers &/or programs (current & past)
Strategic plan, organization chart, promotions
Media Contacts
We will contact the local media for interviews with Connie for possible event publicity. Please give us phone and fax whenever possible.
Chamber of Commerce, phone (________)___________________________
Large Bookstores:
Local Television channels and identifiers (Channel 14 KCBS, Channel 7 KABC etc.):
Drive-time radio shows and/or hosts:
Local talk shows and/or hosts:
Local newspapers:
Large Community Church or Temple:
Thank you for taking time to complete this questionnaire.
The attendees will really appreciate a tailored presentation and handout.
Your efforts will be rewarded in the form of a more meaningful program!
Please return this to our office ASAP to
insure your program's success. Address: P.O. Box 9075, Laguna Beach, CA 92652-9075
or FAX to 949-494-3009
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