Pre-Event Questionnaire

33%

Please take time to complete this questionnaire so that Theresa Cloud Eagle can tailor her message to your specific needs. Click on the ‘Submit’ button to send the form to Theresa Cloud Eagle. Please keep in mind that your questionnaire should be sent at least two weeks prior to the program date. Required Fields have an asterisk (*) next to it. All information will be kept private.
1) Organization Name
Organization Name:*
2) Meeting Planner or Primary Contact
Name*
First Last
Phone Number (with Extension)*
Email*
Enter Email Confirm Email
Fax Number:
How did you hear about Theresa Cloud Eagle?*
- Website
- Internet Search
- Referral, Please specify
- Other, Please specify
If you responded with "Referral" or "Other", please specifiy below:

3) Program Details
Start Date:*
End Date:*
Start Time:*

: HH

MM
Presentation Duration:*
Location (City/State)*
Program Theme and Title:*
Topic Theresa Will Present:*
Who else is speaking at the event?*
Who have you hired in the past to present to the group?*
Why did you select Theresa for this program?*
Are there other scheduled activities that you would like Theresa to participate during the event?
Additional topics you would be interested in for future engagements:
What is your Speaker Budget for this presentation?*
4) Venue Details
Venue Name:*
Venue Phone Number:*
Venue Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Meeting Room:*
Who will introduce Theresa?
First Last
AV Contact Name:
First Last
AV Contact Phone Number:
Room Setup Contact Name:
First Last
Room Setup Contact Phone Number:

5) Industry and Audience Details
List the biggest challenge facing this audience/industry:*
List any important information Theresa should know about the audience:*
Given Theresa’s area of expertise, what key points would you like conveyed to your audience?*
How do you want the attendees to feel after hearing Theresa?*
What are you most proud of as it relates to this audience?
How will you evaluate the success of the program Theresa conducts?*
List any buzzwords or terms specific to this group Theresa should be aware of:
6) Demographics
Size of Audience:*
Please enter a value greater than or equal to 1.
Men %:*
Women %:*
Age Range:*
Will spouses be present?*
- Yes
- No
Profile your organization and who will be attending (i.e. business of organization, titles, of participants, work they do). What is your target market?*
7) Lodging and Transportation
Hotel Name:
Hotel Address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Hotel Phone Number:
Hotel Confirmation #:
Captcha

To your success,

signature

Soul Success Strategist™

1) Organization Name