Please complete this form and the press the "Submit Questionnaire" button below. This form helps Thom better prepare for your program.
Contact Information |
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Organization
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Program date(s)
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Exact time of presentation
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From To
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* Your name
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Position
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* Your phone
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Ext.
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Your fax
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* E-mail
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Web site
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Transportation |
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Meeting Location
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Meeting Facility
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Meeting Room
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Address
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City
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ST Zip
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Key Hotel Contact
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Their phone
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Ext.
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Distance from Airport to Meeting Facility
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If Thom's hotel is different than the
meeting location.
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Thom's hotel
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Hotel Address
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Their phone
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Ext.
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Distance from Hotel to Meeting Facility
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If any problems or emergencies occur in route to the program, who should Thom contact?
(Please list both numbers)
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Emergency contact
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On-site phone
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Ext.
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Home phone
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Program Agenda |
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Thom's presentation
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Start Time
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End Time
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Thom's introducer
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Name
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Title
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What will be the appropriate attire for the program?
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Attire
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What takes place immediately before and after Thom's presentation (another speaker, meal function, break, etc.)?
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Before
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After
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Key Contact List |
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Which two people can Thom interview over the telephone to further tailor the event to your needs?
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Contact name
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Position
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Company
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Address
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Telephone
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Ext.
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Fax
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E-mail
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Contact name
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Position
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Company
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Address
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Telephone
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Ext.
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Fax
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E-mail
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Officers of the Company/Association (or send a flowchart)
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Name
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Position
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E-mail
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Name
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Position
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E-mail
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What State and National Associations does the organization belong to?
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Name
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Position
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Name
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Position
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Pleas include with questionnaire if available:
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- Black and white clipart of your logo
- Annual Report (If available)
- Information to help Thom understand your organization
- Video about your organization
- A rough or final agenda of the meeting
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Program Contents |
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Conference Theme?
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What is the purpose of this meeting (annual meeting, training, awards, etc.)?
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What are your specific objectives for Thom's presentation?
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Are there any sensitive issues that should be avoided?
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What behavior changes do you hope will be achieved/what results are you hoping for?
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Which other outside speakers will be presenting at this meeting? What are their topics?
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Name
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Topic
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Name
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Topic
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Name
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Topic
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Which area does this group need the most growth in?
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Most audiences want something to help them continue the learning after the presentation.
Which do you prefer?
A copy of Thom's book
The live cassette album
A Video recording
Other:
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Include a Mission Statement for your organization, if available.
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What are your people doing right?
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What do you expect from Thom's message: (i.e. motivate, train, reinforce,generate enthusiasm)? List in order of importance.
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Who is most respected among the audience?
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What are the "buzz" words in your industry for this group?
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What seeds, if any, do you want planted?
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What can Thom do that will add a special touch?
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What are the industry / firm trends that are appropriate for Thom to touch on his presentation?
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Audience Profile |
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What are the major job responsibilities of those in the audience?
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What three main things do you think we should know about your group before addressing them?
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Audience:
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Number attending?
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Are Spouses
invited?
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Yes NO
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Gender Percentage
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Average age
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Age range
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Annual Income Range
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Annual Income Average
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Educational Background
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How are these people paid?
(Salary? Bonus Commission?)
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What are the names and proper titles for the following individuals in your organization?
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President/CEO
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VP of Sales/Marketing
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Director of Training/Education
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Sales Manager
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Meeting Planner
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Background |
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What is the primary product / service that you offer?
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What are the two most important benefits you offer to your customers?
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What are the most common objections received from customers or prospective customers?
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Who are your major competitors in your market areas?
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What are your major weaknesses compared to your competitors?
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What are your major strengths compared to your competitors?
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If you could change your industry (product market), what would you change?
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Your Privacy
Thank you for giving us a little information about you and your company. We will treat your information with total confidentiality and agree not to give, sell or trade your information. We agree this information will be used solely by Thomas Winninger for the purpose of sending you information on services and products.
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