This
questionnaire is designed to help Ms. Starr prepare a program
that
is specifically tailored to the needs of your group. Please
take a moment to answer the questions and email or fax
this form to our office. (Fax: 704-596-9108.) If
you wish to send additional information please include
it at the end of this form.
Your Name:
Your Cell Phone Number:
Your email address:
Audience Information:
Number
of attendees
Major responsibilities
of audience members, and typical job titles
The Program Itself:
Conference
theme:
What is your specific
objective for this session?
Information about
the person who will be introducing me.
Name: Title:
Phone: Email:
Starting time
for my program
Starting
time of entire event
Ending time for
my program
Ending time for
entire event
What takes place
before my program (speaker, meal, workshop)
What takes place
immediately after my program (break, another speaker,
lunch)
Name of: City, Hotel, Confirmation
Number, Meeting Room:
What areas do you
feel need the most improvement?
At the completion of this
presentation what do you
Any other comments
you would like to add:
In case of emergency I should call:
Name:
Day and evening phone:
