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IT’S ALL ABOUT YOU! - PRE-PROGRAM QUESTIONNAIRE

Because all of Bernadette’s presentations are fully customized and tailor to your audience, we respectfully ask you to send copies of any brochures, reports, or other documents explaining the types of products and services you offer, as well as copies of the official program, promotion mailings, pertinent to this engagement. This critical information together with this completed form will assist Bernadette in customizing her presentation for your group.  Thank you kindly for taking this time!  You can either email this form back to us at B@Speakerslive.com or fax it to 505-986-0055.

Your Name:  ___________ Telephone:  __________________ Mobile___________

1. Email Address:_________________________________ Fax:________________
2. Organization:_____________________________Telephone:_______________
3. Mailing Address:_____________________________ Website:______________
4. Event is a
   (  ) Conference
   (  ) Business Meeting
   (  ) Retreat
   (  ) Specific Staff Training
   (  ) Banquet
   (  )Other:_____________
5. Theme:____________________________________________________
6. Your goals for this event:

 

7. Please provide the names of 3 to 5 participants and their telephone numbers who will be attending this event and who Bernadette can call to discuss specifics issues related to the program:
1. ____________________________________Telephone:________________
2. ____________________________________Telephone:________________
3. ____________________________________Telephone:________________
8. Event Location:_______________________ Address:___________________________
9. Nearest airport:__________________________________________________________
10. Ground Transportation:___________________________________________________
11. BOOKED PRESENTATION(S): Estimated number of participants at each program

Date	Start Time	AM or PM	Duration	Participant #
__________	__________	__________	__________	__________
Date	Start Time	AM or PM	Duration	Participant #
__________	__________	__________	__________	__________
Date	Start Time	AM or PM	Duration	Participant #
__________	__________	__________	__________	__________

12. Additional information:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Please fill online and email directly to B@speakerslive.com or fax to 505-986-0055.  Thank you!

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