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Pre-Program Questionnaire Form
  1. First Name(*)
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  2. Last Name
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  3. Company or Association Name
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  4. If your organization has a mission statement, please share it with Don here
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  5. Address
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  6. City
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  7. State
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  8. Zip Code
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  9. Area Code & Telephone Number
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  10. E-mail(*)
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  11. Website
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  12. Is there a site link for this meeting?
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  13. To make Don’s presentation most effective, we would like to schedule a 15 minute conference call with your executive team 2 to 3 weeks prior to this event. Please give us three date/time options. All times need to be EST(Eastern Standard Time.)
  14. Options 1
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  16. Options 2
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  18. Options 3
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  20. What executives will likely participate?
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  21.  
  1. THE PROGRAM
  2. Speech Date
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  3. Speech Beginning Time
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  4. End Time
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  5. How did you hear about Don?
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  6. Did someone recommend him?
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  7. Why did you choose him for this event?
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  8. Don wants to build his speech around your program theme/message. What is your theme?
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  9. What does the theme mean to your group?
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  10. What professional speakers have you used in the past?
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  11. What is on the program just before Don speaks?
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  12. What happens on the program right after he speaks?
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  13. Specific purpose of this meeting (awards banquet, annual meeting, etc.)
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  14. What needs to happen as a result of Don’s participation for you to achieve success? (Please be as specific as possible)
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  15.  
  1. LOGISTICAL INFORMATION
  2. What is the nearest airport to the meeting site?
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  3. What is the name and address of the hotel where you have reserved a non-­‐smoking room for Don?
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  4. Can you provide a confirmation number?
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  5. Don will use a GPS to get to your meeting site. What is the exact address and room name for the speech?
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  6. In case of emergency flight delays, please provide 2 contacts for us to call.
  7. Emergency contact name
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  8. Phone
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  9. Emergency contact name
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  10. Phone
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  11. Would you prefer Don to wear a suit and tie or a golf shirt?
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  12. Is there a dinner reception Don should attend? Details?
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  13. Will an A/V technician be onsite?
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  14. What is the best time for Don to do his A/V and room check?
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  15. Don has a video introduction, but still needs someone to bring him on the stage. What is the name of the person who will do so?
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  16. Email of the Person Introducing Don
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  17. In the video introduction, some clients have chosen to insert a clip of someone in the organization most everyone knows saying “my friend” (as seen in this video) would you be interested in doing this at no additional cost?
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  18.  
  1. AUDIENCE ANALYSIS
  2. Number at attendees
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  3. Percentage Male
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  4. Percentage Female
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  5. Spouses attending?
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  6. Are attendees there voluntarily or is it mandatory?
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  7. What separates your high-­‐performance people from others?
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  8. What are the most important changes and/or challenges happening in your company and industry?
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  9. What are your victories as a company/association/team?
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  10. What are the sensitive issues? Topics/subjects not to be mentioned?
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  11. OTHER DETAILS
  12. Don distributes bookmarks detailing the 16 Characteristics of Greatness. How many bookmarks should Don provide?
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  13. Will there be someone onsite who can help distribute them?
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  14. What is the contact information for that person? Name, Email and phone number:
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  15. THANK YOU!