Please complete the following questionnaire if you have scheduled for Judi to speak/present at your event.
Your First Name (required)
Your Last Name (required)
Your Phone Number (required)
Your Email Address (required)
Business/Organization Name (required)
Business/Organization Website (required)
Street Address
City
State/Province
Zip/Postal Code
Country
Meeting Date
Length of Presentation
Beginning Time of Presentation
Ending Time of Presentation
Judi's Role (i.e. Opening Keynote, Breakout Session, Luncheon Speaker, etc.)
Type of Meeting
Program Theme
Appropriate Attire
Program should be targeted to:
Key areas/topics Judi should address:
Three people (including contact information) Judi can call to familiarize herself with your organization:
Name & Contact Information of Introducer
Names and titles of company executives speaking before Judi:
Other professional speakers on the program:
Other professional speakers you have used in the past:
What did you like about their programs?
Number of Attendees
Percentage Male
Percentage Female
Age Range
Makeup of Audience (i.e. Customer Service, Sales, Vendors, etc.)
President/Executive Director (Name and Contact Information):
VP of Sales & Marketing (Name and Contact Information):
VP of Customer Service (Name and Contact Information):
HR Director (Name and Contact Information):
Training Manager (Name and Contact Information):
Important changes happening in your industry/company:
Challenges and/or concerns of senior management:
Company/Association/Team accomplishments:
Company Slogan/Philosophy
Are there any issues which should not be mentioned?
What is the nearest airport to the meeting site?
Transportation to/from airport/meeting site: (i.e. meet Judi, have Judi take a cab)
Hotel Name
Hotel Address/Location
Hotel Distance to Meeting Site
Contact Name & Phone Number (In case of emergency or flight delays)
Would you like to purchase any of Judi's books for attendees? YesNoUnsure
Contact information for person who makes the decision:
Please send the following information to Judi when it is available:
