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III. For Meeting Planners

Pre-Program Questionaire

Contact Data:

Organization:

Program Date:

Name of preparer:

Phone Number:

Fax Number:

E-mail:

The Program:

Purpose of the gathering:

Theme for this event:

Specific location of program:

Start and end times for the facilitator's presentation and program activities that precede and follow the presentation:

Your specific objectives for the facilitator's presentation:

What behavior changes, results or outcomes would signal that this presentation was successful?

Other professional speakers who will be participating in this program and their topics:

Your Organization:

Significant events/developments in your group, organization or industry over the last year:

Recent breakthroughs and achievements:

Current challenges:

Sensitive issues that should be avoided:

Audience Profile

Number of Attendees:

Percentages:

Male Female

Average Age:

Educational background:

Major job titles and job responsibilities of attendees:

What 2-3 main things should the facilitators know about working with this group?:

Other attendees (spouses, special guests, association reps?):

Contact information for 3-5 attendees representing a typical cross section of the group, whom the facilitators could contact in advance for background information to help with their preparation:

Names	Job Titles	Phone	E-mail
1.
2.
3.
4.
5.

Other:

Any specific requests, cautions, advice that you would offer:

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