Please fill out as much of this questionnaire as is applicable. The information will help me customize my show to your group.

Title

E-mail Address

Voicemail

Fax

Company Address
Company/Organization name

Street

City

State
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Zipcode

About the Event
Name of the Event

Date

Month ---Select Month--- January February March April May June July August September October November December>

Day ---Select Day--- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Year ---Select Year--- 2005 2006 2007 Call me in 2006

Tell Gary about the audience:

Name of CEO/President/ highest ranking
person that will be in attendance

What, approximately, are the characteristics of you average member?
* Age
* Male/Female ratio
* Educational background
* Size of audience

Is the attire formal, business suits, or casual?

What speakers have you used in the past few years for this role?

6. Name and title of person introducing me?

What are the objectives for this session?
Please be as specific as possible

Is there a theme you would like woven into the presentation?

What three things should I know about your
audience before addressing them?

Is there someone attending who is exceptional in this field?
Example: Joe Schmuckatelly has led the sales force the last 3 years.
Name/Position
Name/Position

What are the most significant events to have occurred in
your industry or your group this past year?

Have you any other suggestions to help me
make this program your best ever?

As your audience is leaving,
what comments will you hope to hear?

What industry are you in?
Main competitor:
Company website:
How do you stand apart?

What three struggles do your employees/members face?
Please be as specific as possible:
Not enough people to handle the workload,
‘Who wrote this software we have to use?"
” Why can’t I have my own cell?"

Any current problems that are causing stress within the group:
new management,
possible layoffs,
having to write with pen instead of pencil?

And of course some humorous tips:

Is there someone that will be attending the show that,
if the situation is appropriate, can be ‘picked on’?
This person must be well known and liked by at least 75% of the group.
Name and title:

Something interesting about that individual that most
everyone will be aware of: an example might be,
this person might have a BBQ sandwich for lunch everyday.

Are there any catchy phrases your leader uses
that are run into the ground and would
get a laugh if used in the show?

Any ‘local’ color or humor about the area?

Anything that should not be mentioned?

Any other comments: