| PRE-PROGRAM QUESTIONNAIRE:
Please take a moment to answer all applicable questions pertaining to your event so we can meet your objectives and provide you with a customized presentation. After Michele receives your information by mail, a phone appointment will be scheduled to finalize the details.
PROGRAM:______________________________________
DATE:__________________________________________
1. What is the specific purpose/theme of this meeting? (annual meeting/awards/motivation)
2. What are your specific objectives/results desired from this seminar? What is Michele’s role?
3. Size of organization: Large Corporation Mid-size 100-500 less than 100
Audience Analysis: # of Attendees___ Avg. Age____ % Male___ % Female___ % Spouse___
4. What are 3 things I should know about your group:
1. __________________________________________________________________________
2. __________________________________________________________________________
3. __________________________________________________________________________
5. Name of my introducer:________________________ Title:_________________________
Ph#: _______________ Fax: ___________________ Email:___________________________
6. Exact times of Michele Guzy’s presentation: Starting________________ Ending________
7. What takes place immediately before/after Michele’s program? (speaker/meal/break/close)
8. If there will be another speaker, please indicate person and topic:____________________
9. Describe the most significant changes this group has experienced during the last 12 months.
10. Is there any special jargon or terminology used in your industry that would be helpful to me?
11. Are there any sensitive issues or terms to avoid?
12. If this program could help your group do one thing better in business, what would it be?
13. What are some of the professional challenges they have faced? What are some accomplishments?
14. Will the session be audio or video taped?_________________________________________
Whom should I contact to obtain copies?______________ Phone: __________ Email:_______
15. Please send the following information about your company and event if available:
· meeting agenda/invitation
· company newsletter/paper/flyer/product brochures
· industry magazine
· special promotions/campaigns
· mission statement/vision
· annual report/history
· other
16. Is there any additional information that Michele needs to know?
GENERAL INFORMATION:
Meeting Planner:________________________________ Phone:____________________
Fax:___________________________ Email:____________________________________
Organization:_____________________________ Company________________________
Address:_________________________________________________________________
City:___________________________ State:_________________________ Zip:_______
Emergency Contact: ___________________________Title:_________________________
Phone: (hm)____________________ (wk)____________________ (cell)_______________
Meeting Location/Hotel:_______________________________ Meeting Room:___________
Phone:___________________________Fax:______________________________________
Address___________________________ City:_______________ State________ Zip______
Will Michele be staying at same hotel as meeting?__________________________________
If not, please book the closest hotel for Michele to stay at: Hotel:____________________
Address: ________________________ Phone:___________________ Fax:______________
Will the hotel room be billed to your master account? (yes / no)
Confirmation Number:_____________________________________________________________
Please book roundtrip airfare from the Burbank Airport in coach (Y class), business or first class.
Will you be booking reservations or would you like Michele to book travel and bill you?
Closest Airport:________________________ Distance to meeting site? Miles_______ Time:____
How will Michele be transported to the event: (rental car, taxi, limo, pick-up service)
to/from airport:_____________________________ to/from meeting:_______________________
pick-up person:_____________________________ phone:_________________ cell:__________
Please mail your information to:
Michele Guzy
c/o HMI
18607 Ventura Blvd. Suite #310
Tarzana, CA 91356
ph/fax: (818) 340-2045
micheleguzy@yahoo.com | 
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