Dr. Chandler George
Employee Health & Fitness Program
Pre-Program Questionnaire

meetingplanner@drgeorgedc.com 

Office: (817) 488-8384
Fax: (817) 488-8399

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.

Attendee 1 Attendee 2 Attendee 3
Name
Title
Phone
Email

 

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:

    Speaker 1: Topics:

    Speaker 2: Topics:

    Speaker 3: Topics:

Name of: City, Hotel, Confirmation Number, Meeting Room:

    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?

    Challenge 1:

    Challenge 2:

    Challenge 3:

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:

    Name:

    Day and evening phone:

    

 

 Dr. Chandler George
Phone: (817) 488-8399
Fax: (817) 488-8399
Email:
meetingplanner@drgeorgedc.com

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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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