Date of presentation:
Name of organization
Theme of event:
What specific objectives do you have for this presentation?
About the audience
Percentage of male to female (ie. 50/50):
Typical educational background:
Average years job experience:
Major job responsibilities of audience:
What issue is of most concern to for this audience?
What would make this presentation most meaningful for them?
What significant events have taken place in the past year that have affected your members?
What related workshops & presentations have members participated in this past year and what were the results?
Would you be willing to make a preprogram survey available to your members?
Your contact information
Name and title
Email or fax your completed form to: