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Pre-Meeting Questionnaire
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 fully answer all the questions.

Please send me as much information as possible to help increase my understanding on
your organization. This includes association magazines; news releases, newsletters or
other information you feel would be of value to me.

Required information is in bold black text.
Contact Information  
Meeting Planner Organization
Address Address (line 2)
City State / Province
Country Zip / Postal
Phone Fax
Email Website
Other Contact (Alternate Contact or for Emergency)  
Name Phone
Email    
Program Logistics
Conference Dates Date of Program
Exact times of Darren Jacklin’s presentation? Start: End:
Where will Darren Jacklin’s Program be Held?
Hotel Meeting Room
Address Address (line 2)
City State/Province
Country Zip/Postal
Phone Fax
Email
Program Events  
What awards or announcements are there?
Will there be a meal served before or during the program?
Will there be an open bar before or during the program?
Will you be using Image Magnification (IMAG) Yes   No  
Will a video crew be on site? Yes   No  
If yes, please provide:  
Contact person Phone number
If there is a scheduled function the evening prior, what is the time, place, nature and appropriate dress?
Audience Analysis Information  
How many attending?    
About what % male? % What % female? %
Average age?    
Positions/Occupations % Staff or Line

% Management

% Directors 		 
Are spouses invited? Yes   No
From which States (US) or from which Provinces (Canada)?
From which Countries (if International)
Names/positions of the most senior level people who will be there?  
Name   Position  
Name   Position  
The Program  
What is your program theme?    
What type of meeting is it? (e.g. annual meeting, awards banquet)  
Please list two major results you would like to achieve from:  
 * Your Conference
1. 2.
 * Darren Jacklin’s Program
1. 2.
What would make Darren Jacklin’s program truly outstanding for you?
What is your specific objective for the session?
Are there any specific issues or topics you think I need to discuss during the program?
Key issues to avoid if any:
Name and title of the introducer:
What takes place immediately after Darren Jacklin's program (break/another speaker/nothing)?
If other speakers are on the program, who are they and what are their topics?
What Professional Speakers have you had in the past?
Speaker    Year   
Speaker    Year   
What did you like or dislike about their performance?
Would you like Darren Jacklin to autograph his books for your group after his program?
Yes   No
If yes please indicate if you would like to:

Pre-purchase books as a gift for each member

Have books shipped to the site for sale
General Background Information  
What’s been happening in the last six months?
Major Changes?
Traumatic incidents?
Significant accomplishments?
What are some of the current challenges experienced by your
industry/organization/people?
What are the top three challenges faced by the people who will be in my audience?
1. 2. 3.
What are the 3 most important things Darren Jacklin should know about your group?
1. 2. 3.
With what jargon should Darren Jacklin be familiar with? (Acronyms, titles)
Who are your 3 major competitors?
1. 2. 3.
Please list 3 people who represent the typical audience member, with whom Darren
Jacklin can speak with in advance:
Name Phone Email

Name Phone Email

Name Phone Email

Any other Comments?
        
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