Pre-Program Questionnaire

Motivation, Keynote Speaker and Trainer Desi Payne wants to customize her program to your organization. Please complete the online form below OR download the Pre-Program Questionnaire, fill it out, and return it as an attachment to desi@desipayne.com.

Online Pre-Program Questionnaire

Please allow time to fill out this online form; review all the fields and make sure you can answer all the questions first. Leaving this page will not save your entries upon return.

Your Information

First Name

Organization

Last Name

Position

Phone

Event Details

Event Date

Start Time

End Time

Event Address

Event City

What takes place immediately BEFORE Desi speaks?

What takes place immediately AFTER Desi speaks?

Any breaks? Yes or No When?

Name of person introducing Desi

Introducer's Phone Number

Introducer's Email

Who are the attendees (management, sales, executives, etc.)?

Name of CEO, President or Manager of Company?

Number of attendees?

Average age range?

Will spouses be attending?

% Male attendees

% Female attendees

Will there be any special guests and if so, who?

Dress for the meeting?

Sensitive issues that should be avoided?

What is the purpose and/or theme for this event? (annual meeting, sales meeting, awards, training, etc.)?

What specific objectives can I help you to accomplish at this meeting?

Please list any other speakers who will be presenting, and speakers you’ve had in the past.

Are there any people you would like me to recognize? Please include reason, if desired.

About Your Organization

Briefly describe your products and services.

Who is your customer?

Who is your biggest competitor?

What are some of the major challenges currently facing your industry?

If I could wave a magic wand to solve a problem or improve the climate in your organization, what would it be?

How long has the organization been established?

What is the mission or philosophy statement of your organization?

What are the most humorous events that have occurred within your organization during the past year?

What three specific things do you think I should know regarding the people attending?

Please list a few job situations/duties that can cause stress to members of the audience as they do their work.

During the past year, what significant events occurred in your company or organization?

Two names of good-natured people that I could use to participate in the program

Female Name and Title

Male Name and Title

Important Logistical Information

Key person(s) and phone numbers I can contact to get additional inside information

The name of the conference room/ballroom in which Desi will be speaking

Hotel Desi will be staying in

Closest airport to the hotel:

Approximate travel time from airport to hotel (in minutes):

Confirmation #

Distance from airport to hotel (in miles):

Ground Transportation:

Please list any other travel details here.

Emergency Contact Information

Emergency Contact Name

Emergency Contact Number

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Motivational Humorist & Keynote Speaker