Program Development Questionnaire

Please take a few mintes to complete this brief survey. It will enable Capiz to customize a program for your audience and give you the best program possible. We know your time is valuable, so only answer those questions you feel will provide information she should know.

Your Name:
Your Title:
Business Phone:
Fax Number:
Street Address:
City:
State:
Zip Code:
Email:
Web Address:
Event's Sponsoring Organization:
Event's Name:
Type of Meeting:
Dates:
Venue:
City:
State:
What type of program do you want?
On what day(s) whould Capiz speak?
What topic should Capiz address?
Second topic, if any?
Expected audience size for:
Keynote:
Breakout:
Other:
Management Mix:
% Senior Managers:
% Middle Managers:
% Supervisors:
% Non-Managers:
Who are other speakers you have used?
On what topics did they speak?
What does this audience specifically like about its speakers?
What does this audience dislike about its speakers?
Briefly describe attendees' (ages, education, work responsibility etc.)
What are their current challenges and/or "burning issues"?
The most important thing you want people to take away from Capiz's presentation:
What industry jargon will help Capiz connect with this audience?
What sensitive words, phrases or issues should Capiz avoid?
Who will introduce Capiz? (include title or role in organization)
What percent of the audience will know his/her name?
How should Capiz be dressed?





What happens right before Capiz speaks?
When will the room be available for Capiz to set up?
What happens immediately after Capiz speaks?
Are there attendees Capiz might contact to better understand this audience?
Name:
Title:
Phone:
Name:
Title:
Phone:
Name:
Title:
Phone: