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Please take a few
minutes to complete this questionnaire so that we may develop a program that
addresses your specific needs. If you are unsure of an answer or you feel
that a question is not relevant, please leave it blank. Use your Tab key to move
to the next field.
IMPORTANT:
When you finish, click
the "Submit Form" button at the bottom of this page so that your information will be sent to us (you will receive an immediate
confirmation). You may wish to print this page first for your records. Thank you!
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Contact Information
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Meeting Planner |
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Your Name |
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Title |
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Organization |
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Work Phone |
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E-mail |
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Whose Meeting Is This? (If not yours) |
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Name |
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Title |
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Organization |
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Work Phone |
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E-mail |
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Meeting Logistics
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1. What is
the date of your meeting?
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2. What is the start and end time for this
portion of the program?
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3. Where will the meeting be held?
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4. What is
the nearest airport (if not in Atlanta)?
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| 5. What
is the purpose of this meeting? |
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6. What is the title or theme of your meeting? What will it mean to your group?
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What is the budget range for this program (if known)? |
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How will
the room be arranged? |
Flexible
Classroom - tables and chairs
Rows
of chairs only (no tables)
Round
tables
U-Shape
Other:
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9. Will alcohol be served before or during the program?
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Yes No
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Organization Overview
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1.
What is the primary product/service that your organization, or its members,
provides?
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2. Who are your major competitors and what differentiates you from your
competition?
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Group Demographics |
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1. Estimated number of participants
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2.
How well do the participants know each other?
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3. Gender
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Men %:
Women %:
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4. Age
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Range: Average:
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5. Average education
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6. Average annual income
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7. Do all participants speak English?
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Yes No
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8. What are the participants' job titles/occupations and
major job responsibilities?
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9. What other professional speakers or trainers, if any, has your group enjoyed
in the past and what did you like about them?
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Challenges and Opportunities |
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1. What are the biggest challenges or most important issues facing your group
right now?
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2.
What are the biggest opportunities for your group right now?
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3.
What limiting beliefs/behaviors do some group members have that keep them or the
group from being more
successful?
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4.
What fears/worries/concerns do some group members have that keep them or the group from being more successful?
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5.
What's at stake? If your group does not successfully deal with these challenges and embrace these
opportunities, what might the impact be?
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had to assign a cost to the above impact, what would you estimate? |
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Program Specifics
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1. What are your top three objectives for this program?
Please be very specific.
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1.
2.
3.
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2. As a result of
this program, what do you want
participants to know, feel, and do?
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3. Please check any of the following topics or skills that you
would like to include in your program: |
How to:
Set and achieve breakthrough goals
Move beyond limiting beliefs
Build a positively stellar team
Increase trust and morale
Lead and/or motivate team members
Work with different "personality" styles
Identify and capitalize on the strengths
of each team member
Deliver winning presentations
Sell your products, services or ideas
Be a
good listener
Reduce conflicts
Maintain a winning attitude
Thrive in the midst of change
Others:
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4. What would "turn on" your group during this program? |
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5. What would "turn off" your group during this program?
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6. What can we do that will add a special touch to the
program?
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Additional Insights |
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1. Please add any other information you believe will be helpful to customize
your program.
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2.
Please list the names, titles, and phone numbers of three key people that we
may call for additional insights (calls will not be made until we speak with you
again).
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IMPORTANT:
Click the "Submit Form"
button at the bottom of this page so that your information will be sent to us (you will receive an immediate
confirmation). You may wish to print this page first for your records.
If you have any difficulty, you can fax it to us
at 404.286.3526.
Thank you!
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