Pre-event Form

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Please use the form below to submit your information for an upcoming event. This will help us better plan for this event.

Event Information
Name
Title
Organization
For Program
Date(s)
Organization Web Site
Approximate number of attendees
Theme and purpose of this event?

What are the results that you would like from this session? Short Term? Long Term?

What would it look like if we did an outstanding job for you?

Please provide a brief audience description

What takes place immediately before and after the program? (speaker, meal, break)

If there is another speaker, please indicate the topic: (Before and After)

Appropriate Attire for Speaker
Person who will introduce Dave
Name
Title
Phone
Fax
Email
Stage Manager
A stage manager will be available? (If no, skip next 3 questions)
Name
Phone
Email
Audio/Video
The session will be audio taped?
The session will be video taped?
Who can I contact about obtaining a copy of tapes?
Phone
Meeting Planner
Name
Phone
Address
City
State
Zip Code
Email
Travel
Closest Airport
Name (If someone is picking Dave up)
Cell Phone