Event Speaker Questionnaire

Please fill in the questionnaire below in as much detail as possible.  This will help us to tailor the presentation specifically for your company.  All information will be kept private and confidential and will be held ONLY by us for communication with you.

CONTACT INFORMATION

1. Your Name(required)
2. Title(required)
3. Company / Organization(required)
4. Brief description of your company(required)
5. Email(valid email required)
6. Address 1(required)
7. Address 2
8. City/Town(required)
9. State/Province(required)
10. Zip/Postal Code(required)
11. Country(required)
12. Work Phone(required)
13. Home Phone
14. Website
15. Best time for us to reach you
16. M-F 9am-5pmEveningsWeekends
17. Cut-off date to book speaker(required)

THE EVENT

1. Event Title
2. Event Description
3. Event Dates & Times
4. Duration of presentation
5. Type of Meeting / Conference
6. Type of Presentation KeynoteBreakout SessionWorkshopMastermindGroup Coaching
7. Event or Speaker Theme(s)
8. Objectives for speaker presentation
9. Jason's role in the program
10. Sensitive issues to avoid in the presentation
11. Will attendees be eating during Jason's presentation?
12. YesNo
13. Will there be coffee / lunch break before or after Jason's presentation?
14. YesBeforeAfterNo
15. Will Jason be granted promotional opportunities at event?
16. YesNo
17. Who will be the master of ceremonies?
18. Who will be introducing Jason?
19. List additional professional speakers & topics
20. List professional speakers you have used in the past
21. Specific likes / dislikes about their performance

AUDIENCE / ATTENDEE ANALYSIS

1. # Attendees expected(required)
2. # Attendees booked
3. Are spouses invited?
4. YesNo
5. % Males vs Females
6. Average age of attendees
7. Average income of attendees
8. Attendee positions
9. Main concerns / frustrations that you would like to see change & improve
10. Area your company would like to improve

COMPANY INFORMATION

1. Main things we should know about your company / group
2. What does your company do?
3. Target markets / industries for your company
4. Describe your average customer
5. Primary product / service you sell
6. Your major competitors
7. Additional comments or information that would be useful in customizing this presentation for you