Pre-Meeting Questionnaire

Please fill out this form and submit below.

Official Company Name 

Division 


Where will the event take place?

Address 

City, St, Zip 


What is the title of your event? (including subtitle or promotional lines)

What kind of meeting is it? (annual meeting, awards banquet, etc.)

What is Dr. Myers’ role in the program? (Opening or Closing Keynote, Luncheon Speaker, etc.)


Who are the other professional speakers on this program?

Speaker 

    Topic     Day

Speaker 

    Topic     Day

What professional speakers have you used in the past?

Speaker 

    Topic     Date

Speaker 

    Topic     Date

Speaker 

    Topic     Date

What did you specifically like/dislike about their performance? Why?


What are your organization’s objectives for Dr. Myers’ presentation?


Audience:

Total number expected 

Number of men 

Number of women 

Are spouses invited? 

Yes    No

What do you expect your audience to gain from the presentation?

What three main things should Dr. Myers know about your group?


Who will be the key contact(s) prior and during the event?

Primary Contact 

Title 

Work Phone 

Cell Phone 

Secondary Contact 

Title 

Work Phone 

Cell Phone