Pre-program questionnaire
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Transition Man Johnny Campbell
Motivational Speaking   Training Corporate

This questionnaire is to help us help you achieve total success in the MISSION of your event.

Please complete all fields that apply, and also send us any printed  information you feel would best help us understand your organization such as: orientation manuals, product and/or service brochures, annual reports, newsletters or magazines, etc. Be sure to include any promotional mailings and the agenda for the meeting.

Preliminary Information
First Name Last Name
Company Title
Phone Fax
E-mail Website
What is the best time to reach you?

A. What is your program THEME?

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


C. Who is responsible for calling this meeting? (HR, Sales, Marketing?)

Name Title

D. What is the name and title of Johnny’s introducer?

Name Title
Phone E-mail

E. Exact times of Johnny’s presentation? (Please attach program agenda)

Starting Ending

F. When is the best time for Johnny to do his A/V and Room Check?

Option 1 Option 2

G. What is Johnny’s role in the program (Opening or Closing Keynote, Luncheon  Speaker, Breakout, etc.)?


H. Is a photograph and/or program blurb needed for advertising purposes?  Yes:   No:

If Yes, to whom should it go?

Name Title
Phone E-mail

I. Who are the other professional speakers on this program?

Speaker 1 Day & Time
Speaker 2 Day & Time

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

Speaker Date
Speaker Date
Speaker Date
Speaker Date

K. What did you specifically like about their performance? Why?


K1. What did you specifically NOT like about their performance? Why?


L. Would you like information about Johnny’s learning materials to reinforce the impact of Johnny’s ideas after his presentation?  Yes:   No:

II. Logistical Information

A. What is the nearest major airport to the meeting site?
 Distance to meeting site from the airport?
 Miles: Estimated time:


B. For transportation from the airport to the meeting site would you prefer:

To have Johnny met at the airport? Where

To have Johnny take a cab? Approximate cost

N/A (Local Chicago Area)



C. Exactly where is the meeting?

City State/Prov
Phone Fax
Website Meeting Room

D. Where will Johnny be staying?

City State/Prov
Phone Fax
Website Meeting Room


Will you be using Image Magnification (IMAG)? Yes: No: Will a video crew be on site? Yes:   No:

Video Co. Contact Name
Phone E-mail

F. If Johnny has any problems/emergencies on his way to the program, who should he contact? (Please include business, cell, and home number)

Name Business
Cell Home
III. Audience Analysis

A. Audience

Attending Spouses?  Yes:   No:
M/F Ratio %/% Average Age
Job Titles

B. Toward which group should Johnny primarily direct his presentation, and why?


C. What are the names and numbers of four people Johnny can contact for  customization?

Name Phone
Name Phone
Name Phone
Name Phone

D. What is the greatest challenge your organization is facing?

IV. Background Information

A. What are three things you want people to remember when the presentation  is completed?


B. Are there any issues that should be avoided?


C. What three main things should Johnny know about your group?


D. Is there any jargon Johnny should be familiar with (acronyms, titles?)


E. On which target markets/industries does your organization primarily focus?


F. Who is your typical customer?


G. What is the primary product/service that you sell?


H. Who are your major competitors?


I. Any additional comments or information that would be helpful in tailoring the presentation for your group?

    Corporate Speaking