Pre-Program Questionnaire

This Pre-Program Questionnaire will enable Francine to fine-tune her presentation to the exact needs of your group. Feel free to skip over any answers which would merely duplicate answers to previous questions or which might be irrelevant due to the nature of this program. Your help will increase the value of this program to your audience!

* Required fields
* Client:
* Email Address:
* Phone number:
* Hotel where I'll be staying:
* How far is my hotel / airport from the event?:
* Will I be picked up at the airport?:
 Yes No
If so, by whom?:
* Why did you select me as the speaker?:
Conference Theme:
* What is your speaker budget?
* Desired Outcomes / specific objectives:
Are there sensitive issues to be avoided or specifically addressed?:
* Format of my presentation:
 panel discussion
keynote
breakout session/workshop
* How long am I to speak?:
* Exact time of my presentation(s)?:
* Will there be a coffee break?:
 Yes No
* Number of attendees (estimated):
* Group Demographics
(race, gender, age, income level,
or any other relevant info):
* Will you duplicate my handouts for the program?:
 Yes No
* Would you like to discuss purchasing a copy of Esteemable Acts or other items for each audience member?:
 Yes No
* May I sell product?:
(e.g., books, workbooks, CDs, tapes, etc.)
 Yes No
If so, do you expect a percentage? How much?:
Do you tape the program?:
 Yes No
* May I tape the program?:
 Yes No
* Do you cover expenses?:
 Yes No
* Do you pay a fee or honorarium?:
 Yes No
Do I make my own travel arrangements or do you?:
Is my hotel put on your master account or will I be responsible for providing a credit card upon arrival to cover it?:
 Put on Master Account
Own Responsibility
 

 
 
Francine Ward, JD, Esteemable Acts
PO Box 1239, Mill Valley, CA 94942
Phone: 415-389-0975
Contact Francine
   
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