I. Program Sponsor

Mr Ms Mrs Other

*First Name:


*Last Name:


Title/Rank:


Department:


*Organization:


*Address:


Address:

*City:


*State/Province:


*Zip:


*Country:
 


*Phone Number:

Best day and time to call:


Fax Number:


*Email Address:


Web Site Address:


Check here if you are planning this event for another organization and complete the following two questions.
NOTE: We will not contact the sponsor until you direct us to do so.

Name of the event sponsor:

Website of the event sponsor:

II. The Program

Which of John's topics have you selected?
Leadership Innovation Synergy Negotiation Undecided

Do you have a program theme selected? yes no
If YES, please indicate theme here:

What does the theme mean to your group?

What is the purpose for the event?
(annual meeting, sales meeting, conference, corporate retreat, etc.)

Summerize the mission/vision of your organization:

Who is responsible for calling this meeting?

Please give a brief overview of the demographics of those attending:
(predominantly male, female, younger, older, etc.)

What do you want to achieve at this meeting?

What are the greatest challenges the group is facing?

Has the group experienced any special successes or failures recently?

Are there any special or sensitive issues of which John should be aware?

If you have had similar meetings in the past, who were your speakers?

What else should John know about your group and/or

III. Date/Time

Where will the event be held?

What are the dates of the total program?
From To

What are the dates and hours you would like John to be there?
From To
From To

Who will be speaking:
Before John:

After John:

Is John to be:
Opening Speaker Closing Speaker N/A

Is there anyone who wants to meet with John:
Prior to his presentation Following his presentation

IV. The Venue

Event Location

*Location Name:

Address:

Address:

City:


State/Province:


Zip:


Country:
 

*Contact person at location:


Contact Phone Number:


Contact Fax Number:


Contact Email Address:

Type of Facility:


Meeting Room Name or #:


Room Setup:


Audience Size:

Age Range:


Will Spouses be in Attendance?
Yes No

What type of attire will the group be wearing?
Formal Business Dress Business Casual
Casual l

Other Attire (explain)


What job titles will be represented (check all that apply):
Exec Leadership Sr Management Mid Management
Supervisors Salaried Employees Hourly Employees

Where will John be staying?

Location Name:

Address:

Address:

City:

Nearest Airport:

Travel time to and from airport:

John prefers to be met at the airport by either a representative of your organization or a limo service.
Will this be possible? yes no

If YES, please specify details here:

If NO is taxi or rental car available?

Who will be introducing John?

V. Crises Prevention

If John should encounter any last minute problems or emergencies enroute-

Who should he contact?

At What Phone Number?

Primary #:

Pager #:

Alternate #:

Thank you!