Kevin’s Event Materials
Jackie’s Event Materials
Bio
Introduction
Pre-Program Questionnaire
Publicity Photographs
Room and A/V Needs
Kevin & Jackie’s Event Materials

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Pre-Program Questionnaire

Help Jackie Freiberg hit a home run at your meeting by completing the following form.

Name of Organization:
Name of Meeting:
Date of Meeting:
How did you hear about Jackie?
Why did you choose her for this event?

Note: If the audience members are not a part of your organization, please answer the following questions from the viewpoint of the audience.

About Your Program
  What type of meeting is it?
Annual Meeting
Quarterly Meeting
Award/recognition Event
Other:
What is your specific objective for the overall meeting?
What is the theme of your conference or meeting?
  What attire is appropriate for speaking at your event?
Business
Business Casual
  What are your specific objectives for Jackie’s session? What would you like the audience to walk away with?
1.
2.
3.
  What speakers has your audience heard in the past?
Name Topic
Name Topic
Name Topic
  What have you appreciated about speakers you have heard in the past?
  What have you disliked about speakers you have heard in the past?
About Your Industry & Organization
  What major products and/or services does your organization provide?

 
  What clients or customers do you serve?

 
  Who are your major competitors or threats?

 
  What are 3 or 4 major changes facing your industry/organization?
1.
2.
3.

4.

 

  What are 3 or 4 major professional challenges for your audience at this event?
1.
2.
3.

4.

 

About Your Audience
  How many people will be attending Jackie’s presentation?

 
  What is the percentage of men & women in the audience?
Men % Women %

 
  What is the average age of the audience?

Age range?

 
  The majority of the audience will have how many years of experience in the industry?
years

 
  What are the major responsibilities of audience members?

 
  Jackie would like to have a 20-30 minute research phone call in preparation for this event. Who would be the most informed person for this call?
Name
 Title
Organization
Phone  
E-mail address

  In addition, please identify three movers and shakers in your organization who will be in the audience. With your permission, Jackie would like to send them three to five questions for research and customizing information.
Name
Title
Organization
E-mail address
Name
Title
Organization
E-mail address
Name
Title
Organization
E-mail address

Logistics & Schedule
  What time does the entire program begin and end?
Begin

 

 End

 
  What time does Jackie’s presentation begin and end?
Begin

 

 End

 
  What takes place immediately before Jackie’s program?

 
 

What takes place immediately after Jackie’s program?

Please provide an agenda for the day Dr. Freiberg speaks.
Please provide pronunciation for Freiberg (Fry-burg) to the person introducing Jackie – Thank you
  Person introducing Dr. Freiberg (Fry-burg):
Name
Title
Organization
Phone number

E-mail address

 

Audio/Visual
  When will the meeting room & a/v technician be available for Jackie’s a/v check?
Date

Time

 

(Please request at least 60 minutes prior to presentation.)

Who will be the a/v technician Dr. Freiberg will be working with?
Name
On-site cell phone number
E-mail address

 

Person responsible for room set up:
Name

Cell phone number

 

Recording & Taping
Audio or video recording of the presentation in part or whole for anything other than archival use is not a part of our agreement. Should such a program reproduction and usage be desired, we will be pleased to provide a separate quotation.

If you are audio or video recording for archival purposes please provide us with a digital master copy of the tape within 14 days after your event.
 

This program will be:

 

If you are audio or video recording for archival purposes, it is required we are provided with a digital master copy of the tape in either miniDV, DVCAM or Betacam within 14 days after your event.

PLEASE NOTE: Audio or video recording of the presentation in part or whole for anything other than archival use is not a part of our agreement. Should such a program reproduction and usage be desired, we will be pleased to provide a separate quotation.

Travel Information
  Event Site
Name of Event Site
Address
City
State Zip
Phone Fax
Name of Meeting Room

 
  Nearest major airport to arrive?
Distance to the meeting site
in terms of miles?

 

 time?

 
  Hotel
  Where have you reserved a room for Jackie?
(non-smoking room/king-size bed)
Hotel name
Address
City
State Zip
Phone Fax
Reservation confirmation number

  Car Service
  For transportation between the airport and meeting site, Jackie requires a sedan and driver. Please make these arrangements and send us:
Name of Sedan Company
Contact Information (Ph#)

Where will Jackie be met?

 

Pickup location for return to airport

 

Return pickup time:
Confirmation number:
Inbound trip
Oubound trip

Hotel to Event if needed
Time

 

 Location

 
Distance from hotel to event site
Miles

 

 Minutes

 
  Emergency Contact
  In case of an emergency, who should Jackie contact?
Business Phone:
 Home Phone:
Cellular Phone:
  
Taking the Message Home!
Jackie will provide instructions on where to access her Free slides after the presentation. Jackie DOES NOT sell anything from the podium, she just gives the audience resources to fuel their continued success.

Please provide the contact information for billing:
Name:
Title:
Company:
Address:
City, State, Zip:
Telephone:
Fax:
E-mail:
This form was completed by:
Name:
Title:
Company:
Address:
City, State, Zip:
Telephone:
Fax:
E-mail:
Web Site:
When you have finished filling out this form, press this button to send it to us!