PreProgram Questionnaire

This questionnaire is designed to help John tailor his message to the specific needs, interests, and background of your audience. The information you provide will allow John to gain a better understanding of your organization, mission and purpose. We value the time you provide in answering these questions.

Name of Individual Completing this Questionnaire*
Email of individual completing this PreProgram Questionnaire*
Section 1: General Information about the meeting
Company/Organization Name*
What is the date of the event?*
Date Format: MM slash DD slash YYYY
What is the time of the event?
: HH
MM
What time would you like John to arrive at your event?*
: HH
MM
What time is John's presentation scheduled to begin?*
: HH
MM
What time is John's presentation scheduled to end?*
: HH
MM
Specific Location of your Event (venue name, street address, room #, etc.)*
Theme of the meeting?
Company/Organization Twitter Handle (if applicable)
What is the attire of the audience members for this meeting?
Name of contact person at event:*
Cell Phone Number
Name of volunteer assigned to John:*
Cell Phone Number
Will there be a projector for PowerPoint?*
What is your preferred slide format (based on screen size)?
Will there be a lavaliere microphone?*
What program/event is scheduled immediately before John's presentation?
What is the program/event that follows?
Any other function (meal, reception, seminar) you would like John to attend, if possible?
Function Description
Date
Date Format: MM slash DD slash YYYY
Time
: HH
MM
Specific Location (venue name, street address, room #, etc.)
Hotel accommodations for John (if applicable) will be made by:
- Your Organization
- John's Team
Hotel Name
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Confirmation Number
Ground Transportation for John, if applicable. (If Speaker's choice, please leave blank.)
- John will be met at the airport by a transportation/limo service.
- John will be met at the airport by a member of your organization.
- Taxi/Uber
- Rental Car
Company Name
Driver's Cell
Name
First Last
Cell Phone
Section 2: Tell us a little more about the group
Estimated number who will be in the audience
Average Age
Male/Female ratio:
Educational Level
Average number of years with company or organization:
Job titles/functions of people in the audience:
What percentage of your audience truly wants to be at this meeting?
Section 3: Questionnaire
Please note: the more information you can provide, the better John will be able to tailor his message to your audience.
Names and titles of any executives or VIPs John should be familiar with?
What are the most pressing challenges or problems faced by members of your group?
Reflecting on previous challenges that your group has overcome, please identify how success was accomplished, and relate any similarities between previous challenges and today's challenges.
What are your specific objectives for this program?(What do you want your people to gain, what changes in attitude do you desire, what actions do you want them to take, etc.?)
In what areas do you want participants to stretch and go beyond their comfort zones?
Based on your audience participants, what would you identify as their personal mission and drive? Why do they continue to strive for success within your organization?
What can be done to improve your participants' personal and professional missions?
Are there any issues or topics you want me to avoid during the program?
What is the single most important message this group should hear?
Why did you choose John O'Leary as a speaker for your event?
Other suggestions, advice, or concerns?

PreProgram Questionnaire

Section 1: General Information about the meeting

Section 2: Tell us a little more about the group

Section 3: Questionnaire

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