Bill's Pre-Program Questionnaire

Name of Group(Required)

Date of Presentation(Required)

Name of Event(Required)

About You

Person completing this form:(Required)

First Last

Your email:(Required)

Your phone #:(Required)

Program Logistics

Meeting Time: Begin(Required)

Meeting Time: End(Required)

Bill's Program Time: Begin(Required)

Bill's Program Time: End(Required)

Bill's 2nd Program Time: Begin

Bill's 2nd Program Time: End

Customization Info

What is the theme for your event, if any?

What are some of the challenges currently experienced by your industry and attendees? What's REALLY keeping them up at night?(Required)

What is the biggest misconception that "outsiders" have about your industry/business?(Required)

Why are you interested in the topic of innovation?(Required)

What innovations (current and historical) are associated with your industry and/or group?

Please list three “pet peeves” that this audience would relate to. Or, to put it another way, if several members of this audience were having drinks together, what would they start griping about after the 3rd beer? How would they complete the sentence, “It just drives me crazy when…”? Please give specific examples, if possible (e.g., “When customers call in just before closing to demand early delivery” instead of just “Customers.”)(Required)

What's something Bill could mention from the stage that would have the attendees think, "Now how in the WORLD did he know THAT?!" (If you can think of more than one, so much the better!)(Required)

Is there anything Bill should NOT mention, or sensitive areas he should avoid?

What are the three most important things you'd like attendees to take away from this presentation?

What would you like your attendees to think or do differently as a result of Bill's program?(Required)

Event Logistics

Will there be other speakers at this event?

Yes

Topics:

Approx. number attending Bill's program:(Required)

% Male:(Required)

% Female:(Required)

Age range of audience:(Required)

Average age:(Required)

Will spouses/SO's be attending?

Yes

General job responsibilities of attendees:

How can Bill refer to the entire group by job title or function (e.g., Health Care Professionals/Financial Advisors/Small Business Owners/Librarians)?(Required)

What % of attendees are in leadership roles?

Travel

Closest airport:

Approx. distance from venue (in miles):

Ground transportation:

Taxi/Uber/Lyft

Shuttle

Will be met by driver

Other

If Bill will be met at airport, where will driver meet Bill?

Hotel name:

Hotel phone:

Hotel confirmation #:

Hotel address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is the meeting happening at the hotel?

Yes

Meeting location (if not hotel):

Phone

Meeting location address (if not hotel):

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Final Questions (whew!)

Name of room where Bill will speak:

What will be happening immediately before Bill's Program?(Required)

What will be happening immediately after Bill's program?(Required)

What day and time will the room be empty for A/V setup and sound check?(Required)

Group contact on site (name):(Required)

Group contact on site cell #:(Required)

A/V contact on site (name):

A/V contact phone: