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Clarence Reynolds - Changenomics
Pre-Program Questionnaire

   
Clarence Reynolds needs your help! This questionnaire enables Clarence to increase the value of his presentation. Please answer all relevant questions skipping over any that may not apply.

Your response to these questions is the first step. Upon receipt, we will contact you to set up a pre- conference phone meeting to insure Clarence understands your objectives for his appearance. Thank you. We appreciate your time and attention to these details.
   
If you have any questions, please contact Clarence Reynolds at 404-775-9869.
Select the highlighted area next to the prompt and begin typing.
   
THE EVENT  
   
1. Name of organization
2. Address of organization:
3. Name of event (annual, quarterly, sales training, etc.)
4. Event date(s): Begins
    Ends
5. Event location
6. Event theme
   
CLARENCE REYNOLDS PRESENTATION  
   
1. Date Clarence is speaking
2. Start time of presentation
    End Time
3. Room in which Clarence is speaking
4. Event function  
    General session keynote
    Concurrent session or Breakout
    Luncheon
    After dinner
    Other
5. What happens immediately before Clarence speaks?
6. What happens immediately after Clarence speaks?
7. Clarence’s presentation topic
8. Name of person introducing Clarence
9. Best time for Clarence to do AV check
10. Speaker’s attire
11. What are the three most important objectives for Clarence’s presentation
 
 
 
12. Are there sensitive issues that should be avoided?
   
AUDIENCE PROFILE  
   
1. Approximate number in attendance
2. Are spouses invited?
Yes No
3. Percentage of males/females
4. Average age of audience
5. Who will be attending (i.e., executives, managers, employees, customers, clients, etc.)?
 
6. List the top challenges of your organization
7. In what ways do you expect Clarence to address those challenges?
 
GENERAL BACKGROUND INFORMATION  
   
1. What is the primary product or service your organization provides?
 
2. Please provide a brief description of your organization/company:
 
3. Who is your organization’s target market?
4. What term is used to refer to your customer (such as customer, patient, client, buyer, etc.)?
 
5. Is there any jargon Clarence should be familiar with (acronyms, titles, etc.)?
 
6. Who are your primary competitors?
7. In the last year, what have been the most significant changes in your industry?
 
   
LODGING & GROUND TRANSPORTATION
Hotel reservations are to be made by the client and billed directly to client, so that Clarence Reynolds does not have to utilize his credit card upon arrival (except for incidentals when necessary).
   
1. Name of hotel
2. Address of hotel
3. Telephone
4. Confirmation # for Clarence’s reservation
5. Date(s) of lodging
   
AIR TRAVEL  
   
Fees for air travel are negotiated in the speaking contract. Clarence is responsible for making all airline reservations. Client will be notified once flights are booked.
   
1. Nearest airport
2. Distance to hotel from airport
   
GROUND TRANSPORTATION  
   
1. Distance from airport to hotel
2. Ground transportation upon arrival in host city (from airport to hotel):
Taxi Shuttle Service Arranged car or limo service
a. If hired car, name of transportation company:
b. Telephone contact in event of emergency
c. Confirmation #
d. Will driver meet Clarence at baggage claim or curbside?
 
3. Ground transportation from hotel to venue (if different from hotel)
 
Time of pick-up from hotel
4. Ground transportation from venue back to airport:  
Taxi Shuttle Service Arranged car or limo service
a. If hired car, name of transportation company:
b. Telephone contact in event of emergency
c. Confirmation #
   
AUDIO VISUAL REQUIREMENTS for KEYNOTE PRESENTATIONS:

The following are required:
• One wireless lavaliere microphone
• Small table to hold a bottle of water and a stemmed glass
   
If this is a concurrent session or training segment, the above requirements remain the same.
Have these arrangements been made?
Yes No
   
KEY CONTACTS
These contact numbers (cell phones and on-site professionals) are to be used in
case Clarence has a question or concern, or in case of emergency on the day
before or day of the event.)
   
Primary contact for Clarence’s appearance  
Name
Title
Office phone
E-mail
   
Primary on-site contact at the event  
Name
Cell
E-mail
   
Secondary on-site contact at the event  
Name
Cell
E-mail
   
 



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