CONTACT INFORMATION
Name of Organization or Group:
Website Address:
Contact Person & Title:
Work Phone Number:
Cell Phone Number:
Best Time to Reach You:
Address:
City
State
Zip
Email Address:
PROGRAM INFORMATION
Topic Choice #1:
Program Date:
Program Start Time:Hours01
02
03
04
05
06
07
08
09
10
11
12
:
Minutes00
15
30
45
AM
PM
Program End Time:Hours01
02
03
04
05
06
07
08
09
10
11
12
:
Minutes00
15
30
45
AM
PM
Break Time (if applicable):
Topic Choice #2:
Date:
Start Time:Hours01
02
03
04
05
06
07
08
09
10
11
12
:
Minutes00
15
30
45
AM
PM
End Time:Hours01
02
03
04
05
06
07
08
09
10
11
12
:
Minutes00
15
30
45
AM
PM
Break Time (if applicable):
EVENT INFORMATION
Meeting Location:
City:
State
Zip:
What is the Conference/Meeting Theme?
What are your goals and objectives for my portion of your program?
How can I assist you in meeting these objectives? What 2 or 3 points would you like made?
How will you know if I am successful? (Please define a target)
Would you like worksheets to copy as handouts?Yes
No
Page Number Limit for Handouts:
Preferred format (if any):
Who will be introducing me? (Name, Title & Email address)
ROOM SET-UP
Please describe the room, including stage and seating setup for the meeting:
Who will be the A.V. contact person?
Their phone number:
Their email address:
When is the A.V. setup and sound check?
THE AUDIENCE - Who will be attending this presentation?
Job Titles:
Age Range:
Gender Mix:
Departments:
How large will the group be?
What is the general attitude of the group?
What is their attitude towards this topic?
Are there any areas of discussion you prefer be avoided, or sensitive issues I should be aware of?
What is the mission of your company or group?
What are the current stressors or challenges you are facing?
What is special or unique about the people in this audience? (languages, disabilities, etc.)
ADDITIONAL INFORMATION - I want to be sure that your group has a great event. Please provide any other information you feel would be helpful in customizing this presentation.
What is happening before and after my presentation?
Please list other speakers, their topics & their time slots:
Buzzwords I should be aware of:
Any Pet Peeves?
Inside Jokes:
Audience Members you would like Mentioned:
Names & phone numbers of anyone you'd like me to talk with for input?
Is there anything else I can do to ensure the success of your event?Meet and Greet Attendees?
Attend a Reception?
Share Meal or Banquet with Attendees
TRAVEL INFORMATION
Closest Airport
Number of miles from airport to meeting site & hotel:
What form of transportation will be provided to the meeting site?
Will someone be meeting me? If so, please provide name, cell #, location, and time:
Specific directions to the meeting location & contact person at the meeting site:
HOTEL INFORMATION (if applicable)
Hotel Name:
Hotel Address:
City:
State:
Zip
Phone Number:
Reservation Confirmation Number:
Will the hotel be directly billed to you (the client)?
WHAT ELSE? Is there anything else that we didn't cover above that would be helpful for us to discuss?
I look forward to working with you to present the best possible presentation to your organization. Please send copies of program brochures, agendas, or other promotional materials so my presentation is consistent with your advertising. I'd also appreciate any newsletters, articles or information on your group/organization you feel would be helpful. All information can be mailed or emailed to: mmdwk@peoplepc.com or Maryann Murphy, 53 Tracy Lane, Mashpee, MA 02649
