You can print out this form, complete it, and mail it back to Jeff; or if you prefer, you may complete an on-line form and send it via email by clicking here.

Group: ______________________________        Meeting Date: ______________________

Please fill out completely to help ensure that Jeff Davidson’s presentation meets your needs. Or, give Jeff a call, and he’ll be happy to walk through it with you.

Your Goals for this Presentation

What is your organization’s mission or philosophy?
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What is the purpose and/or theme of this meeting?
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What are the two biggest challenges facing your industry?

1. _________________________________________________
2. _________________________________________________

What are the two biggest challenges facing your organization?

1. _________________________________________________
2. _________________________________________________

What are the two most common types of interruptions facing your attendees?

1. _________________________________________________
2. _________________________________________________

What are you proud of as an organization or industry?

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What happens before and after Jeff speaks?

Will there be:

___ A trade show?	___ A directory of trade show exhibitors?
___ Executive or director sessions?	___ Spouse or partner sessions?
___ A conference guide?	___ An attendance roster?

Are there any buzz words or technical terms of which Jeff should be aware?

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Are there any taboo topics/issues/terms of which Jeff should be aware?

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Success Factors

What major concept or know-how do you want attendees to retain from Jeff’s program?

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How will you evaluate the success of the program Jeff conducts?

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Audience/Organization Profile

Number of attendees: ______	Average education: ______________
Average age range: ______	Experience levels: ______________
Male/female ratio: ______	Salary/income range: ______________

Will spouses attend? ______
Is staff attending? ______

Here are the three most important things Jeff should know about the group:

1. _________________________________________________
2. _________________________________________________
3. _________________________________________________

Which individuals should be specifically recognized and why?

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The Meeting

In addition to Jeff’s presentation, would you like Jeff to participate in any scheduled functions?

Time: ____________________________
Dress: ____________________________
Location: _______________________________________________
Nature of Event: _________________________________________

Is there anything else Jeff needs to know to present the best program for you?

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PLEASE SEND Jeff a copy of your meeting agenda or invitation, any organization newsletters, papers or flyers, or other promotional materials for this event. Please call at anytime with questions.