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!