Name of Company or Group: (required)

Your Email (required)

Business Industry:

Business Function:

Attire of Attendees:

Number of Attendees:

% Male

% Female

% Management:

What will be happening immediately before and after my presentation? (Please send a program agenda when available.)

Please list some descriptive job titles of participants:

Average educational level of participants:

What are the real "headaches" going on in this industry or your particular company or association at this time?

Please list a few industry related "gripes" that you might hear on a typical day on the job:

Please list a few things that would make your participants happy on the job:

What would you like me to accomplish during this presentation? For example, if you are asking for a "motivational" talk, what specific changes are you hoping to see in the participants? (e.g., better sales, happier customers, more fulfilled employees, etc.)

What percent humor to message/content do you prefer?

Please add anything else you think I need to know about your group or industry while preparing my presentation. The more I know, the better!!