Client Pre-Program QuestionnaireName of Client or Group:      

Date of Program:      

Program Title:      

This questionnaire is designed to help us prepare a program that is specifically tailored to the needs of your group. Please take a moment to answer all the questions as completely as possible, but feel free to skip those which would duplicate a previous answer or which might be irrelevant to your group. Then return the form to our office NO LATER THAN TWO WEEKS BEFORE THE ENGAGEMENT. If you need additional space, please feel free to add a page or write on the back.

Please include whatever information is available which you feel would help Lenora understand your organization’s people, products, services and industry. Lenora would rather have too much information than too little. Printed information could include:

© 2012 Lenora Billings-Harris, CSP

Client Pre-Program Questionnaire Meeting specific agenda required Program promotional brochure

A link to diversity page of company website (if it is intranet only, please send as .PDF file)

Logo: Please email a company logo for use on the customized handouts to Lenora@LenoraSpeaks.com.

The purpose of this questionnaire is not to create additional work for you, but to significantly increase the value of the program for your people. Thank you!

Two Ways to Complete This Form1. Complete this form online at http://lenoraspeaks.com/questionnaire.aspx2. Print out this questionnaire

a. Complete it by handb. Fax it back to Lenora at 336.282.4487 orc. Scan and email to jen@lenoraspeaks.comd. Mail it to the address below

Lenora Billings-Harris, CSPPO Box 1628

Greensboro, NC 27402

© 2012 Lenora Billings-Harris, CSP

Client Pre-Program Questionnaire

CLIENT CONTACT INFORMATIONContact Information for the primary person Lenora should contact for any aspect of this program:

Name:       Title:      

Address:      

Phone:       Fax:      

Email:       Website:      

In case of emergency the day or evening before the event, who should I call?Name:      

Day Ph:       Night Ph:      

LogisticsMeeting Information

Venue Name:      

Location Address:      

Phone: (     )       Fax: (     )      

Meeting Room:      

Will someone be meeting Lenora at the airport? Yes No

Who:      

Where:      

If no one is meeting Lenora at the airport, what is the best way to get to the hotel?

Taxi Limo Other (Explain)

Lenora’s Hotel InformationPlease indicate closest hotel to venue (prefer Marriott family of hotels)

Hotel Name:      

Address:      

Phone: (     )    Fax: (     )      

Distance from meeting venue in miles:       in minutes:      

© 2012 Lenora Billings-Harris, CSP Page 3 of 7

Client Pre-Program Questionnaire

THE MEETING

Start Time:       End Time:      

Lenora’s Start Time:       Lenora’s End Time:      

Meeting Attire: Business Casual Business Semi-Formal Formal Other      

What happens before and after Lenora’s talk (i.e. speaker, workshop, break, meal)?

Before:      

After:      

Are there any other speakers on the program? If so, please identify them by name, title and topics they will discuss:

Name Title Topic

                 

                 

                 

Who will introduce Lenora? Name:       Title:      

Phone: (     )       Email:      

Meeting Theme:      

Specific purpose of the meeting:      

Top 3 objectives for Lenora’s presentation: 1.      

2.      

3.      

Key or sensitive issues to avoid (if any):      

Are there any messages that you would like Lenora to reinforce?      

Are there any issues/topics in particular that you think I should discuss during the program?      

Have you any other suggestions to help us make this program your best ever?      

What is your Twitter hashtag for this meeting/event? If you do not yet have one, please create one so that your

attendees may share information about the session.      

Audience AnalysisNumber of attendees:       Female %       Male %      

Average age ranges(Check the majority group): 25 26-35 36-45 46-55 56

Spouses invited: Yes No

General description of audience:      

© 2012 Lenora Billings-Harris, CSP Page 4 of 7

Client Pre-Program Questionnaire

What are the names/titles of your key people (leadership)?

Name: Title Yrs with Co/Org

                 

                 

                 

                 

Employees are referred to as: employees team members associates Other      

What are the top three challenges faced by the people who will be in my audience?

1.      

2.      

3.      

What other information should Lenora know about the audience?      

When your people depart from this presentation what ONE thing do you want to be uppermost in their minds?      

The OrganizationWhat is your company mission statement?      

What is the overall focus or mission of the organization for the year?      

What is your organization most proud of?      

What are your company/organization colors?      

Do you have any key phrases you often use?      

What do you consider the primary strengths of your organization/people?      

What are your primary products and/or services?      

Who are your customers by type?      

© 2012 Lenora Billings-Harris, CSP Page 5 of 7

Client Pre-Program Questionnaire

Name three industry periodicals or associations that are important to your group:

1.      

2.      

3.      

Please provide a several-sentence “state of your industry” statement:

     

What are the most significant events to have occurred in your industry/organization/group during the past year (i.e. expansion, relocations, reduction in workforce, new laws, etc.)?

     

Do you have any corporate “heroes” (other organizations or leaders admired, studied or referenced by your managers)?

     

Please share with me any "industry color" (i.e. promotions, unusual regulations or policies, Murphy's Law in action etc.):

     

What diversity and inclusion programs have the audience members attended?

     

Using only 3-4 adjectives, please describe the kind of speaker who has been a big hit with this group:

Adjective 1       Adjective 3      

Adjective 2       Adjective 4      

How did you hear about Lenora? Speaker’s Bureau Website Word of Mouth

Read a book or article by Lenora Heard Lenora speak

Other      

What prompted you to hire Lenora for your event? (Please check as many as apply.)

Demonstrated expertise Video Preview

Bureau recommendation Book or article written by Lenora

Used Lenora before Heard Lenora speak

Other

What speakers have you had in the past?      

Depending on the success of this presentation, what other presentation topics would be considered for the future?

     

© 2012 Lenora Billings-Harris, CSP Page 6 of 7

Client Pre-Program Questionnaire

Other Resources

Books & Tapes

Clients are often interested in providing a learning resource or gift to attendees such as a book, audio or videotape to extend the value and impact of Lenora’s presentation. Would you be interested in discussing this option? Yes No

Web Links

Please feel free to create links from your website to ours if you’d like to introduce your group to Lenora prior to her presentation. Some useful links Include:

Home Page – www.LenoraSpeaks.com Preview Video – www.lenoraspeaks.com/pages/video.html Books & Tapes – www.lenoraspeaks.com/pages/products.aspx Articles by Lenora – www.lenoraspeaks.com/pages/articles.html

E-zine

Lenora publishes a monthly ‘ezine’ called Multicultural Musings: The Diversity Advantage E-Zine.

To subscribe your group, simply send a list of email addresses to the attention of adminc@earthlink.net. Subscriptions are free and you can unsubscribe at any time. We adhere to a strict privacy policy. Individual subscribers can go to www.lenoraspeaks.com/pages/ezine.aspx to sign-up.

© 2012 Lenora Billings-Harris, CSP Page 7 of 7