Please print this page. Return the completed form at least one month before
the event.
FAX: (858) 486-8595. Or mail to Tom Hinton, P.O. Box 880774 - San Diego, CA
92168-0774.
Organization:
Program Topic:
Meeting Location:
Address:
City , State, Zip:
Phone:
Fax :
Nearest airport from hotel and speech:
Distance from airport to lodging:
Distance from lodging to speaking location:
Mode of transportation from the airport to the hotel?
Mode of transportation from hotel to speaking location?
If problems/emergencies arise on my way to the program, whom should I contact?
Name:
Business phone number:
Home phone number:
Email address:
Name and title of my introducer:
What takes place immediately before my program?
Other speakers (name and topic):
Entire program: Start time/End time:
Tom's program:
Date:
Start time :
End time:
What takes place immediately after my program?
How many people will be in the audience?
% Female:
% Male:
THE PROGRAM
1. What are your specific objectives/results desired for my session?
a.
b.
c.
2. Are there any issues/topics in particular that you would like me to discuss in the program?
Key issues to avoid (if any):
Special jargon/terminology to use:
3. What is the purpose of this meeting (annual meeting, awards, etc.)?
4. What is the mission/philosophy statement for your company?
How long has the organization been in business?
5. What are some current problems/challenges/breakthroughs experienced by your organization/industry?
6. What are the three top challenges faced by those attending?
7. List the three greatest strengths of people attending my session.
8. List the three greatest weaknesses of people attending my session.
9. What areas of their work performance are in need of improvement?
10. What do you want them to do that they are not doing now?
11. Key person(s) I can contact to get additional inside information.
Name
Title
Company
Phone #
Name
Title
Company
Phone #
12. What are the most significant events that have occurred in your organization/industry during the last year?
13. What are the most humorous events that have occurred in your organization/industry during the past year?
14. Funny mistakes the company or individuals have made:
15. With whom in your industry do you have an adversarial relationship? (For example, F.D.A., doctors, lawyers, etc.)
16. Are there any people you would like me to recognize? Please include reason, if desired.
17. Please give me up to 10 names of willing people I could use to participate in the program. Please include phone number or email addresses.
NOTE: It is important that any participants that we use
1) are well known to the group, and
2) have a good sense of humor and would enjoy the attention, rather than be
embarrassed.
18. Please send any brochures or materials regarding your organization that will be useful in customizing her presentation.
19. Is there anything else you want me to know prior to the presentation?
20. May I audiotape or videotape this presentation if desired?
21. May I sell my education products before or after the presentation?