1.   Your Name:
        Title:
        Company/Organization:

  2.  Your Contact Information:                                                            

        Phone Number:
        Fax Number:
        E-mail Address:
        Website:
        Best time for our office to reach you:

 

 3.   What is your conference theme?

 

 

4.What are your specific objectives for the speaker's presentation?

 

 

 

5. What are sensitive issues that should be avoided?

 

 

 

6. Date & Time frame of presentation?
Date: __________________
From: ____________ am/pm
To: ______________ am/pm

 

 

7. What takes place immediately before and after the speaker's presentation?

 

 

 

8. Who are other speakers on the program (if any)?

 

 

9. What professional speakers have you used in the past?

 

 

10.What did you like most about their performance?  Least?
 

 

11.How many audience members do you anticipate?

 

 

12.Is this a specialized group or general public? If specialized, please explain details.

 

 

13.Please list (3) items you believe the speaker should know before addressing your group:

 

 

14.What are the most significant events that have occurred in your industry, organization, school,  and/or group this year?

 

 

15.What is your objective/goal for your audience?