Pre Program Questionnaire

Great information builds great programs. Help Patricia do the best job possible when speaking for your organization. Please answer the following questions on-line (just fill in your comments and click 'Send') or print this form, complete it and fax to Patricia Katz at Optimus Consulting (306) 242-0795.

Also, please forward a copy of the full conference or event program and any other information that would be helpful in preparing to work with this group (i.e.- annual reports, brochures, newsletters, etc.)

Contact Data

Organization:
Program date:
Name of preparer:
Phone #:
Fax #:
Email:

The Program

Purpose of the gathering (AGM, training, awards, etc.):

Theme for this event:

Specific location of program:

Start and end times for Patricia's presentation and program activities that precede and follow her presentation:

Your specific objectives for Patricia's presentation:

What behaviour changes, results or outcomes would signal that this presentation was successful?

Other professional speakers who will be participating in this program and their topics:

Your Organization

Significant events/developments in your group, organization or industry over the last year:

Recent breakthroughs & achievements:

Current challenges:

Sensitive issues that should be avoided:

Audience Profile

Number of attendees:
Percentages:	Males Females
Average age:
Educational background:

Major job titles and job responsibilities of attendees:

What 2-3 main things should Patricia know about working with this group?

Other attendees (spouses, special guests, association reps?):

Contact information for 3-5 attendees representing a typical cross section of the group, whom Patricia could contact in advance for background information to help with her preparation.

	Name	Job title	Phone	Email
1.
2.
3.
4.
5.

Other

Any specific requests, cautions, advice that you would offer: