Pre-Event Questoinnaire

Thank you for being willing to fill out this questionnaire. It is so important for the success of the program. Kirk customizes each presentation to the specific needs of his target audience. In addition, he aims to connect to the human spirit of each group. In order to accomplish this, we encourage you, the meeting planner, to complete as much of this form as possible. We understand that not every question will apply. Thank you for your assistance and cooperation.

Contact Information:

Client Name:
Contact Name:
Telephone #:
Fax #:
Business Street Address:
City, State, Zip:
Email Address:
Web Address:

Event Information:

Program Title or Theme:
Dates of Convention or Event:
Is there a website promoting this event?:
Name of Event Location:
Event Location Address:
Is this an annual event?:
If so, is there a web brochure available to view from last years program? Where?:
Who spoke at last year's program?:
About what?:
What was most impactful?:
Event Location Telephone#:
Distance from the Airport:
Kirk's Ground Transportation:
What hotel will Kirk be staying in?
Hotal Address (if different from event location):
Will this be charged to your master account?:
If 'Yes', please provide confirmation #:
Who will be Kirk's contact once he arrives?:
Please provide contact #, cell # and emergrncy #:
What other speakers will be presenting at the same meeting? Please provide their speaking topics:
What date does Kirk speak?:
Who will be introducing Kirk? (Please include title. Introduction for Kirk will be provided):
What is the appropriate attire for Kirk's presentation?:
What time does Kirk's presentation begin?:
What time does Kirk's presentation end?:
What takes place immediately before Kirk speaks?:
What takes place immediately after Kirk speaks?:

Audience and Organization Information:

Brief description of those who will be attending your event:
Approximate # of Attendees:
Are spouses invited?:
Approximate % of males:
Approximate % of females:
Average age of audience:
Age range in audience:
What is the theme of your event?:
What is the purpose of this meeting? Annual convention, training, sales, seminar, etc.:
Please provide company mission statement:
Meeting objectives: (What are the three most important things you want to hear people say as they leave the event?)
Please give a brief description of your industry/association:
What are some of the challenges/changes the target audience is currently facing?:
Please list job responsibilities of those in the audience:
Are there any sensitive issues Kirk should be aware of?:
What are some of the accomplishments the audience has attained in the last 12 months?:
What are the most significant events that have occurred in your industry or organization during the past year? (i.e. mergers, cutbacks, relocations, etc.)?:
What is the primary product/service that you offer?:
Who are your biggest competitors and what differentiates your product/service from that of your competitors?:

Connecting to the Human Spirit:

Please provide some interesting funny stories, accomplishments, and or unique hobbies about specific members of the audience?:
What are your people talking about? What's on their mind? What are the hot topics?:
What are the inside jokes in the industry/organization?:
What are the names of new projects, phrases, acronyms, jargon etc?:
What are some of the group's favorite things to do, or places to go, places to eat, etc?:
What is unique about your group?:
Who are the 'go to' people?:
Please give some quotes or phrases used by leaders in the organization?:
Please give the names of 5 people who could be fun to use for object lessons?:

Product Information:

Many people like to take something home with them after hearing Kirk's presentation. Would you like to:
Purchase materials before the meeting at a discounted rate and present to your audience on site?:
Kirk would be happy to sign and personalize his products for your attendees.
Offer materials for purchase at the meeting?:
Consider sending them as a follow-up afterward?:
Is there any other information that Kirk should be aware of prior to the event?:

Follow Up:

If you enjoy the presentation would you be willing to provide Kirk a letter of recommendation?:
Would you be willing to give a reference that might be interested in Kirk's message?: