Pre-Program Form

Organization Name:

Primary Contact:

Your Email:

Address:

City:

State:

Zip:

Office Phone:

Cell Phone:

Additional Contacts

Name:

Title:

Phone:

Email:

Name:

Title:

Phone:

Email:

Event Information

Event Title:

Event Date:

Event Time:

Event Location:

Event City:

Event State:

Event Zip:

Audience

Total number of attendees:

How will the room be set-up:

Will the attendees have tables?
YesNo

Introduction

Who will be introducing me at the event?

Name:

Phone:

Email:

*I will supply a written introduction prior to the event.

Background

1. What is purpose of this meeting?

2. Do you have a theme or slogan for the meeting?

3. What is the most important objective of your portion of this meeting?

4. What is the most important objective for Chad J. Willett to accomplish in the event?

5. Please describe typical people your audience members usually deal with?

6. What objectives do you want your attendees to achieve in the next 12 months?

7. What hurdles do you face in accomplishing these objectives?

8. What resources are available to help your organization succeed?

Additional Information

1. What industry-related magazines/journals do your participants read?

2. Are there any “in” or “running jokes” of this group?

3. Can you supply a recent company newsletter?

(If yes please send to booking@chadjwillett.com)

*All information shared will be used to customize Chad J. Willett’s keynote addresses and workshops.

**All information received is classified as confidential and will not be reproduced in any form