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Pre-Program Questionaire Form


Taking the time to answer this questionnaire will help Doug Dayton present the best possible program for your group. You can complete this form online.

How did you hear about Doug Dayton?

Speakers Bureau (name / contact)

Keynote Presentation

In-house Seminar

Internet - How did you find our web site?

Doug Dayton's Books

Other

General Program Information

Type of meeting (annual conference, customer conference, etc.):

Theme for your program:

Primary objectives for meeting:

Describe your audience: (job title, objectives)

Number of attendees:

Are spouses invited?

Key executives in your company that will be involved with the event:

President / CEO / COO, etc: (name, title, email address, objectives for program)

Vice President of Sales, etc:

Vice President of Marketing, etc:

Training Manager / HR Director, etc:

Are you interested in information about Doug Dayton's books and seminar materials to reinforce the impact of his ideas after his presentation? Yes No

Background Information

Type of business or association: 

Primary market or industry targeted by your group:

Is there any industry jargon or special acronyms that Doug should be familiar with, which is used in your group?

Describe your typical customer:

What is the primary product or service that you sell?

Who are your major competitors?

Please include any additional information that will enable Doug Dayton to tailor his presentation for your group:

Program Logistics

Date of presentation
Location of Event
Address
City
State
Zip
Telephone
Fax
Meeting room
Starting time
Ending time
Q&A period
Audio recording
Video recording
Teleconferencing
A/V Company
A/V Contact
A/V Contact phone
Time for AV check
How should Doug dress? (suit / business casual)
What is Doug's role in the program? - e.g. opening or closing keynote, luncheon speaker, etc.

Please arrange for written authorization if you would like to tape Doug's presentation.

What speakers will be speaking before Doug Dayton? 

If possible please forward information on their topics to enable Doug to tailor his speech.

What speakers will be speaking after Doug Dayton? Name? Topic?

What professional speakers have you used in the past?

What did you like about their presentations?

What did you dislike about their presentations?

Please describe the time, place and purpose of any function or event the evening prior to Doug Dayton's presentation that you would like Doug to attend.

Please confirm Doug's attendance at any special functions prior to his presentation.

Other Information:

Contact Information for Seminar Coordinator

Contact Name
Title
Company
Address1
Address2
City
State
Zip
Country
Phone
E-mail
Website
Best time to call

Please include the name and telephone number for someone that Doug can reach in case there is an emergency the evening before or the morning of his presentation.  

Emergency Contact
Business Phone
Home Phone
Cell Phone

          




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