Pre-Program Form

Your Information

Name *

First

Last

Email *

Organization Name *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Additional Contacts

Name

Title

Email

Event Information

Event Title

Date / Time

Date

Time

Event Location

Address Line 1

Address Line 2

City

State

Zip Code

Audience Details

Total number of attendees

Selected Value: 0

How will the room be set-up?

Will the attendees have tables?

Yes
No

Who will be introducing me at the event? *

Phone

Email *

Company Background

What is purpose of this meeting?

Do you have a theme or slogan for the meeting?

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

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

Please describe typical people your audience members usually deal with?

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

What hurdles do you face in accomplishing these objectives?

What resources are available to help your organization succeed?

Additional Information

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

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

Can you supply a recent company newsletter?

Yes
No

(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