Questionnaire for Rick Stevenson Speaking Customization BASIC INFORMATION Name * First Name Last Name Organization Phone (###) ### #### Email * Website http:// Date of Program MM DD YYYY Time Hour Minute Second AM PM Number of Attendees Demographics of Audience (Age range, Male/Female Ratio) I never want to accept an engagement upon which I cannot fully deliver and, ideally, surpass all expectations. To that end, I would appreciate you answering as many of the following set of questions as possible: Please provide a brief description/profile of your company/organization What is your conference meeting/theme? When my presentation is over, what major idea do you want the audience to retain? Are there any key words or ideas you want me to emphasize? If so, what are they? Who else is speaking (keynote) at this event? What are the two greatest frustrations currently existing in your company? What is the single greatest opportunity for improvement with your members or company? Why was my presentation potentially promising for your event? What might happen in a day that would ruin a good day? (pet peeves/setbacks) What was memorable about past presenters (positive and negative)? Positive: Negative: Will there be media coverage of the event? Please provide the names of two or three people who will be at the meeting, along with their titles and email address. I may contact them to gather additional insight to your audience. 1. 2. 3. Thank you! HOTEL INFORMATION Hotel: Hotel Phone #: (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Rick’s Hotel Confirmation #: Distance from nearest airport to hotel: If the location is different from the hotel information above, please provide that information. Facility Name: Facility Phone # (###) ### #### Distance from the hotel to the meeting site if different: Proposed Travel Arrangements Emergency on-site name and contact number: Thank you!
