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> PRE-PROGRAM QUESTIONNAIRE

Please take a few minutes to complete this questionnaire so that we may develop a program that addresses your specific needs. If you are unsure of an answer or you feel that a question is not relevant, please leave it blank. Use your Tab key to move to the next field.

IMPORTANT: When you finish, click the "Submit Form" button at the bottom of this page so that your information will be sent to us (you will receive an immediate confirmation). You may wish to print this page first for your records. Thank you!
 

Contact Information

Meeting Planner
Your Name
Title
Organization
Work Phone
E-mail
   

Whose Meeting Is This? (If not yours)

Name
Title
Organization
Work Phone
E-mail
 

Meeting Logistics

1. What is the date of your meeting?
 

 
2. What is the start and end time for this portion of the program?
 

 

3. Where will the meeting be held?
 


 
4. What is the nearest airport (if not in Atlanta)?
 

 
5. What is the purpose of this meeting?
 

6. What is the title or theme of your meeting? What will it mean to your group?
 


 
7. What is the budget range for this program (if known)?

 


 
8. How will the room be arranged?   Flexible
 
Classroom - tables and chairs
 
Rows of chairs only (no tables)
 
Round tables
 
U-Shape
 Other:

 

9. Will alcohol be served before or during the program?

Yes No
   

Organization Overview

1. What is the primary product/service that your organization, or its members, provides?

 


 

2. Who are your major competitors and what differentiates you from your competition? 

 


 
   

Group Demographics

1. Estimated number of participants
 


 

2. How well do the participants know each other?
 

3. Gender
 
Men %:    Women %:
 
4. Age
 
Range:    Average:
 
5. Average education
 

 
6. Average annual income
 

 
7. Do all participants speak English?
 
Yes No
 

8. What are the participants' job titles/occupations and major job responsibilities?
 

9. What other professional speakers or trainers, if any, has your group enjoyed in the past and what did you like about them?

   

Challenges and Opportunities

1. What are the biggest challenges or most important issues facing your group right now?
 


 

2. What are the biggest opportunities for your group right now?
 


 

3. What limiting beliefs/behaviors do some group members have that keep them or the group from being more successful?
 


 

4. What fears/worries/concerns do some group members have that keep them or the group from being more successful?
 


 

5. What's at stake? If your group does not successfully deal with these challenges and embrace these opportunities, what might the impact be?
 


 
6. If you had to assign a cost to the above impact, what would you estimate?
   

Program Specifics

1. What are your top three objectives for this program? Please be very specific.

1.

2.


3.

 
2. As a result of this program, what do you want participants to know, feel, and do?
 

 
3. Please check any of the following topics or skills that you would like to include in your program:

 

  How to:
  Set and achieve breakthrough goals
 
Move beyond limiting beliefs
 
Build a positively stellar team
 
Increase trust and morale
 
Lead and/or motivate team members
 
Work with different "personality" styles
 
Identify and capitalize on the strengths
      of each team member
 
Deliver winning presentations
 
Sell your products, services or ideas
 
Be a good listener
 
Reduce conflicts
 
Maintain a winning attitude
 
Thrive in the midst of change
  Others:

 
4. What would "turn on" your group during this program?   
 

5. What would "turn off" your group during this program?


 

6. What can we do that will add a special touch to the program?

   

Additional Insights

   

1. Please add any other information you believe will be helpful to customize your program.


 

2. Please list the names, titles, and phone numbers of three key people that we may call for additional insights (calls will not be made until we speak with you again).






IMPORTANT
:
Click the "Submit Form" button at the bottom of this page so that your information will be sent to us (you will receive an immediate confirmation). You may wish to print this page first for your records. If you have any difficulty, you can fax it to us at 404.286.3526. Thank you!

   

© David Greenberg's Simply Speaking, Inc.®  Toll-free in the U.S. 1.888.773.2512   www.davidgreenberg.com  


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