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This questionnaire is designed to
help us prepare a program that is specifically tailored to the needs of your group. Please take a moment to answer the
questions and email or fax this form to our office no less than three weeks before the
program. (Fax: (817) 488-8399). If you need to send additional information please include it at the
end of this form.
Special Request:
Please send as much
information as possible to help increase our understanding of your organization. This includes web site address,
association magazines, news releases, newsletters, annual reports and other information you
feel would be of value.
Interviews:
Please send the names,
titles, phone numbers and e-mail addresses of three people who will be attending the conference and who are representative of
the total group. I would like to speak with each of them for approximately ten minutes to gain insights.
What is the overall focus or mission of the
business for the year?
Audience Information:
Number of attendees
Number of males
Number of females
Average age of group
Range of ages
Major responsibilities of audience members, and
typical job titles
Please provide me with the names and titles of your key people
1. Name:
Title:
2. Name:
Title:
3. Name:
Title:
The Program Itself:
Conference theme:
What is your specific objective for this session?
What issues or topics should I focus on during the program?
Key issues to avoid.
Information about the person who will be introducing me.
Name:
Title:
Phone:
Email:
Starting time for my program
Starting time of entire program
Ending time for my program
Ending time for entire program
What takes place before my program (speaker,
meal, workshop)
What takes place immediately after my program
(break, another speaker, lunch)
If other speakers are on the program with
me, who are they and what are their topics:
Name of: City, Hotel, Confirmation Number,
Meeting Room:
Have you any other suggestions to help us make this program your
best ever?
General Background Information:
What do you consider the primary strengths of the people in the
organization?
What challenges is the organization facing?
What areas do you feel need the most improvement?
What are the most significant events that have occurred in your
company or industry
during the past year? ( expansion, relocations, reduction in
workforce, etc.)
What are the top three challenges faced by the people who will be
in the audience?
At the completion of this presentation what do you want to
be uppermost in their minds?
Any other comments you would like to add:
In case of emergency I should call:
Dr. Chandler George
Phone: (817) 488-8399
Fax: (817) 488-8399
Email:
meetingplanner@drgeorgedc.com
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webmaster@drgeorgedc.com
Chandler George & Associates
420 N. Carroll Ave. Ste. 150, Southlake, Texas, 76092
Office:
(817) 488-8384, Fax (817) 488-8399
E-Mail:
info@drgeorgedc.com
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