Dr. Hammerschlag requests that the questionnaire below be completed. If you have any questions please email Somer McCormick at info@healingdoc.com.

Client Name


Meeting "theme" or "objective"

What are your specific objectives for my session?

What do you want the speaker to accomplish?

Have you any special suggestions to help me make this
program your best ever?



What industry or economic trends are affecting those in attendance?

What are some of the major problems/opportunities facing your industry and your organization now?

What issues (if any) should the speaker avoid?

Is there a slogan or philosophy that is commonly used in your association/company?

Is there any industry jargon the speaker should be aware of?

Is there any inside information or humor the speaker should know about?

What takes place immediately prior to speaker's presentation?

What takes place immediately after the speaker's presentation?

Is there a meal function before or after that you expect me to attend if my travel allows? If yes, when is it taking place?

At what time does the meeting/day start?

Times for my presentation?
Start
What time does it End?

Will there be a coffee break? Yes No

Approx. length of Break

Approx. time of the break

Who should my office talk to about making my product available for sale or for scheduling a book signing?

Contact Name

Contact Email

Contact Phone

Who are the other speakers on the program (if any):
Speaker and Topic

Proper dress for speaker
Formal Casual Other Normal business attire

If the speaker has books or cassettes he/she: May make them available May not make them available

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Audience Information: Number of attendees?
Are spouses invited?
Percentage of males?
Females?

Average age of group? Ranges of age?

Average annual income?

Educational background?

What are the exact job titles and responsibilities of those in attendance?

Is there anything that I should know about the audience before addressing them?

What specific activities/behaviors separate your high performance people from your average/below average performers?

What are the names and titles of your top people who will be at the meeting?

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Logistical Information:

If I have any problems/emergencies on my way to the program, who
should I contact (include business and home phone numbers)?
Name
Business phone
Fax phone
Home phone

How do I get from the airport to the meeting site/hotel (i.e. cab, limo, etc)? Limo Driver Other
Hotel Name
Address
City/State
Hotel Phone
Hotel Fax
Will you be making the hotel reservation? Yes No
Will the hotel be billed to your master account?
Yes No
Who should I contact when I arrive at the hotel?
If I'm not speaking in the Hotel where I'm staying, where will I be speaking?
Best time for me to set up and check equipment? (I need 15 min. I would like to test mic, slide projector, etc.)