Rick Barrera - Pre-Program Questionairre

Pre-Program Questionnaire Page 1 of 10

PRE- PROGRAM QUESTIONNAIRE
Download Desktop PPQ | Fill out PPQ On-line

In order for me to present my remarks in a meaningful context, I need to learn more about the key aspects of your organization. This pre-program questionnaire is designed specifically for that purpose. It is an essential tool that will allow me to fully address the unique needs of your organization, your culture and most importantly, your people. If you'd prefer to talk with me over the phone rather than complete the questionnaire, I'd be happy to do so.

Fill out this questionnaire as completely as possible, but feel free to skip any questions or sections you feel would not be relevant or useful. If you're in a hurry, fill out and fax me the Vital Information page, but keep in mind that the more information you provide, the better I'll be able to tailor my remarks. You may (1) fill out this questionnaire by hand; (2) type your responses; (3) record your answers on a cassette/ microcassette; (4) use your computer; or (5) phone me with your information. Whatever method suits you best.

Lastly, the following is a list of background information I'd find helpful, but please send only those items you are comfortable sharing:

Meeting Agenda/Program	Product Catalogs
Company Mission Statement	Annual Report
Company Newsletters	Trade Journals
Articles about the company	Customer Surveys
Other:

I look forward to working with you.

Best Regards, Rick Barrera

Rick's Biography

Client List

Pre-Program Questionnaire

Speech Intros

AV Requirements

B/W Photo

Instructions - Please Read First!

This is a ten (10) page form. Fill each page and section out completely or as applicable from top to bottom. After filling out the entire page, click the "Submit Form" button to send the information to us. Once it is sent, you will automatically be brought to the next section of the questionnaire.
(**NOTE** The "Reset Form" button will erase all information from the page you are currently working on.)
You will notice at the top of each page, there will be fields for you to fill in your Company Name, Event, Event Date, and E-mail Address. THESE ARE REQUIRED TO BE FILLED OUT ON EACH PAGE, and are used to combine all sections for your program.
If you need to re-submit any one section, you can jump to that section by using the navigation section underneath the "Submit/Reset buttons."

Thanks again for taking the time to fill this information out!

VITAL INFORMATION
(The information in this section is critical, please do not leave any question blank)

Your Name, Title:	Organization:

Phone Number:	Fax Number:

E-mail Address:	WWW Address:

Scheduled Date(s)	Time(s)

The exact title you'd like for the speech:	Number of attendees at Rick's presentation:

What will be the appropriate attire for the attendees at my program?	Would you prefer that I dress:
Business Suit Business Casual (Sport Coat and Tie) Casual (Shirt, No Tie) Other:	Business Suit Business Casual (Sport Coat and Tie) Casual (Shirt, No Tie) Other:

HOTEL INFORMATION
(In case we need to ship any materials ahead of time or need directions for ground transportation)

Hotel:	Mtg Room:

Street Address:	City:

State:	Zip Code:

Phone Number:	Fax Number:

Directions:	Closest Airport:

Distance from airport to hotel/meeting site:
Time:	Miles:

If the location of the meeting is different from the hotel information above, please fill out the information below:

Name of Facility	Meeting Room

Street Address:	City:

State	ZIP

Directions from hotel:

Distance from hotel to meeting site:
Time:	Miles:

Because of the frequent changes in my schedule caused by other engagements, airline delays, etc., I find it's easier for both of us if I arrange my own transportation to the meeting. If there is something special I should know, (i.e. you've arranged a limousine, there's a hotel shuttle, I will need to rent a car, etc.) please give me the details below:

If I have any problems or emergencies on my way to the program, who should I contact?

Name:

Business Phone:	Home Phone:

To submit above information and move on to the next section of the questionaire, click the submit form button.