roxanne emmerich · pre-program questionnaire 9521 west 78th street, suite 120 • minneapolis, mn...

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Page 1: Roxanne Emmerich · Pre-Program Questionnaire 9521 West 78th Street, Suite 120 • Minneapolis, MN 55344 USA Local: 952-820-0360 • Toll-Free: 1-800-236-5885 • Fax: 952-893-0502

Pre-Program Questionnaire

9521 West 78th Street, Suite 120 • Minneapolis, MN 55344 USA Local: 952-820-0360 • Toll-Free: 1-800-236-5885 • Fax: 952-893-0502 www.EmmerichGroup.com • [email protected]

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Roxanne Emmerich Keynote Presentations • Seminars Please make a photocopy of this questionnaire and keep it for your files. It is designed to make the program great—without making your life miserable.

Fill out only those areas that apply to your organization. We want to make it easy. If you spoke with a member of The Emmerich Group about certain items via the phone, feel free to skip repeated questions.

Audience

Number in attendance: ________

What are the job titles and responsibilities of attendees? ______________________________________________________________________ ______________________________________________________________________

What is the personality of the group? (Serious, fun loving, etc.) ______________________________________________________________________ ______________________________________________________________________

Percent male: _____ Percent female: ______

Page 2: Roxanne Emmerich · Pre-Program Questionnaire 9521 West 78th Street, Suite 120 • Minneapolis, MN 55344 USA Local: 952-820-0360 • Toll-Free: 1-800-236-5885 • Fax: 952-893-0502

Pre-Program Questionnaire

9521 West 78th Street, Suite 120 • Minneapolis, MN 55344 USA Local: 952-820-0360 • Toll-Free: 1-800-236-5885 • Fax: 952-893-0502 www.EmmerichGroup.com • [email protected]

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The Program

If there is a meeting theme, what is it? _____________________________________________________________________ _____________________________________________________________________

What three objectives would you like your people to meet as a result of this session? _____________________________________________________________________ _____________________________________________________________________

How would you like your people to think differently? _____________________________________________________________________ _____________________________________________________________________

Since feelings have a great impact on changes of behavior, how would you like your people to feel differently? _____________________________________________________________________ _____________________________________________________________________

What do you want your people to DO differently? _____________________________________________________________________ _____________________________________________________________________

Page 3: Roxanne Emmerich · Pre-Program Questionnaire 9521 West 78th Street, Suite 120 • Minneapolis, MN 55344 USA Local: 952-820-0360 • Toll-Free: 1-800-236-5885 • Fax: 952-893-0502

Pre-Program Questionnaire

9521 West 78th Street, Suite 120 • Minneapolis, MN 55344 USA Local: 952-820-0360 • Toll-Free: 1-800-236-5885 • Fax: 952-893-0502 www.EmmerichGroup.com • [email protected]

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Are there any sensitive issues to avoid? _____________________________________________________________________ _____________________________________________________________________

How will the program be promoted? _____________________________________________________________________ _____________________________________________________________________

What other speakers / trainers / consultants have you worked with in the past? What have you liked / disliked about their programs? _____________________________________________________________________ _____________________________________________________________________

How will you measure the success of Roxanne’s presentation? _____________________________________________________________________ _____________________________________________________________________

Program Schedule

What time will Roxanne’s presentation start? _______ End? _______ Break scheduled? ______

Page 4: Roxanne Emmerich · Pre-Program Questionnaire 9521 West 78th Street, Suite 120 • Minneapolis, MN 55344 USA Local: 952-820-0360 • Toll-Free: 1-800-236-5885 • Fax: 952-893-0502

Pre-Program Questionnaire

9521 West 78th Street, Suite 120 • Minneapolis, MN 55344 USA Local: 952-820-0360 • Toll-Free: 1-800-236-5885 • Fax: 952-893-0502 www.EmmerichGroup.com • [email protected]

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Who are the other speakers on the program? _____________________________________________________________________ _____________________________________________________________________

What takes place immediately before / after Roxanne’s program? _____________________________________________________________________ _____________________________________________________________________

Program Site

Site name and address: ___________________________________________________________________ ___________________________________________________________________

Into what airport should Roxanne book her flight? ___________________________________________________________________ ___________________________________________________________________

How far is the site from the airport? ___________________________________________________________________ ___________________________________________________________________

Page 5: Roxanne Emmerich · Pre-Program Questionnaire 9521 West 78th Street, Suite 120 • Minneapolis, MN 55344 USA Local: 952-820-0360 • Toll-Free: 1-800-236-5885 • Fax: 952-893-0502

Pre-Program Questionnaire

9521 West 78th Street, Suite 120 • Minneapolis, MN 55344 USA Local: 952-820-0360 • Toll-Free: 1-800-236-5885 • Fax: 952-893-0502 www.EmmerichGroup.com • [email protected]

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How should Roxanne travel from the airport? (Client pickup, car service, etc.)

___________________________________________________________________ ___________________________________________________________________

Would you like Roxanne to notify someone when she arrives at the hotel? If so, please provide the contact’s name and phone number:

Name: ___________________________ Phone #: _____________________

Are there any pre-meeting engagements you would like Roxanne to attend? (e.g. breakfast or lunch?)

___________________________________________________________________ ___________________________________________________________________

How will the audience be dressed? (circle)

Business Business casual Casual Cocktail

Not to worry: Roxanne has never been late or missed a program in the 12 years she has been doing this. We do, however, like to keep you posted of any challenges of travel. If she has any problems / emergencies on the way to the program, whom should she contact?

Name: ___________________________ Phone #: _____________________

Page 6: Roxanne Emmerich · Pre-Program Questionnaire 9521 West 78th Street, Suite 120 • Minneapolis, MN 55344 USA Local: 952-820-0360 • Toll-Free: 1-800-236-5885 • Fax: 952-893-0502

Pre-Program Questionnaire

9521 West 78th Street, Suite 120 • Minneapolis, MN 55344 USA Local: 952-820-0360 • Toll-Free: 1-800-236-5885 • Fax: 952-893-0502 www.EmmerichGroup.com • [email protected]

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Taping

Do you want to tape the program? Audio: ______ Video: ______

For what use would you do the taping?

___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________

Please fax the completed form to: 952-893-0502