Connie Dieken - Communication Authority

Group Information:
Organization:
Event:
Date:
Time of our presentation:	Length of presentation:
Type of meeting:
If other, please indicate:
Contact person:
Contact's title:
Contact's Phone:	Contact's Fax:
Contact's Email:
Name of person who will introduce us:
Introducer's Phone:	Introducer's Email:
On the day of the event, please provide a phone number in case we need to reach you:
Program Location:
City/State:
Event Site:
Address:
Site web address:
Meeting room:
A/V contact person:
A/V contact phone:
Event site phone number:

Your Program:
Theme:
Significance of theme:
What are your primary objectives for our presentation?
1.
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3.
What specific results would you like our program to accomplish for your audience?
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2.
3.
What are your group’s biggest communication issues?
1.
2.
3.
What conditions have impacted your group?
1.
2.
3.
How can we help you solve your current challenges?
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3.
What jargon should we be familiar with such as acronyms, slogans, phrases, inside jokes, etc.?

Key competitors:

Your Audience:
Anticipated number of people attending:
Number of women:
Number of men:
Typical job titles:
How attendees will dress:
How you would like us to dress:
Attendees we may contact for additional input:
1. Name:
1. Title:
1. Phone:
1. Email:
2. Name:
2. Title:
2. Phone:
2. Email:
Will you have any VIPs in your audience?
If yes, who?
Will media be invited?
If yes, whom?
Are other professional speakers on this program?
If yes, whom:
What traits have you liked/disliked about previous speakers?
Liked?
Disliked?

Flight Info If We’re Flying to Your Event:
Airport:
Airline:
Confirmation number:
First leg of flight:
Departure time:	Arrival time:
Return flight:
Departure time:	Arrival time:
Estimated drive time from airport to the site:
For transportation from the airport to the site, would you prefer: To have someone meet us at the airport
If so, name and mobile phone:
To have us take a cab To have us rent a car
Is so, rental car company:
Rental car confirmation number:

Hotel Info If We’re Staying Overnight:
Hotel name:
Address:
Phone:
Confirmation number:
Thank you. We look forward to your program!