Please fill out this form so that we may assist you in selecting and providing an appropriate speaker or entertainer to fit your program and budget requirements. Meeting Planner Questionnaire Organization Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country Contact Name Name of person who has final say (Pres./Committee Chair) Phone Cell Fax Email Website/URL Event Location Event Location Event Location Event Location City City State/Province State/Province Zip/Postal Zip/Postal Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country Name of Event / Meeting Engagement Date Alternate Date Start Date Length of Presentation # of Programs # of Speakers # of Participants Budget Range (honorarium/fee) $ range, from/to Dignitary, Famous Person, Intellectual, Luminary, Notable, Personage, Philosopher, Prophet, Sage, Star, and Teacher Actor Ambassador Architect Artist Astronaut Attorney Author Broadcast Media Business Leader Character Portrayals Comedian Composer Dancer Doctor Economist Editor & Publisher Emcee Entertainer Entertainment Financial Futurist Governor Health Headline - News Host Humorist Inspirational Insurance International Affairs International Statesmen Inventor Journalist Judge Keynote Leaders Look-A-Like Marketing Master of Ceremonies (M/C) Mayor Member of Parliament Military Leader Motivational Movie National Issues News Officers Photographer Physician Political Leader Prime Minister Prime Minister Professor Radio Sales Scientist Sports Talent Technology Television Personality Theater Vocalist OtherOther What is the Purpose or Objectives of the Upcoming Event? Appearance Association Gathering Autograph Award Presentations Banquet Board Meeting Breakout Session Cabaret Theme Celebration Ceremony Classroom Conference Contest Convention Dinner Program Draw in New Members Educational Session Entertainment Event Exposition Fair Fund Raiser Graduation Ceremony Group Consulting Session Honors Program Hosting Concert Influential Interactive Program Keynote Lecture Luncheon Program Mall Meeting Motivational Networking New Product Introduction Occasion Panel Political Praise Membership Product Endorsement Promotion Reception Retreat Reunion Roast Sales Rally Seminar Shopping Mall Draw Special Event Sports Spousal Program Theatrical Trade Show Training Workshop Wrap Party OtherOther What is your goal in selecting a category? Communication Computer Conflict Management Critical Thinking Delegation Interpersonal Listening Management Memory Negotiation Organizational Planning Presentation Persuasion Reading Sales Speaking Supervisory Telephone OtherOther Example: Our goal is to choose categories for developing skills inherent to becoming successful. Is Ethnicity a Factor in Your Event? Asian/Pacific Islander African-Americans Arabic Armenian British Bulgarian Chinese Czechoslovakian Danish Dutch Estonian Ethiopian Finnish French German Greek Hindu Hungarian Icelandic Indian Irish Italian Japanese Jewish Korean Latvian Lithuanian Manx Norwegian Polish Portuguese Russian Scottish Spanish Swedish Swiss Thai Turkish Ukrainian Vietnamese Welsh Yugoslavian OtherOther Speakers with Disabilities Visually Impaired Hearing Impaired Amputee Cerebral Palsy Wheelchair user Walking Impairment Little people Developmentally disabled Who makes the final decision on the upcoming program? Administrator CEO Committee Member Finance Director Human Resource Director Manager Marketing Director Meeting Planner Owner Program Director Public Relations Director Sales Director Special Events Coordinator OtherOther Do you have a budget for the following categories? Audio cassette tapes Books Entertainers Handouts Historian/Video, Audio Hotel Meals Sound system Speakers Transportation (ground/air) Video tapes OtherOther What are your needs and the needs of the Speaker or Entertainer? Agenda: Outline of your upcoming program Autographing: Will attendees request autographs of your guest Audio requirements Biography of your company (other) Camera ready flyer Cassette Demo Contact person prior to meeting Contract (Agreement) Distance from the airport Exit directions Fee Schedule Food / Beverage - (special diet requirements/schedule) Handouts Host Hotel Introduction Sheet (Name & title of introducer) Liaison List of key personnel List of other speakers/entertainers on the program Marketing Kit Map Media Requirements Media Sheet Objective of meeting Permission & Arrangements for Back-of-Room Sales Permission for audio Permission for videotaping Photo opportunity Press Kit Profile of your organization Program Reprints of News releases Schedule/Time in front of Group Size of Group Theme for meeting Time keeper Time Zone: Eastern, Mountain, Pacific, etc. Title of speaker's talk Travel Policy/Land, Air: Arrangements requirements: arrival & departure Video OtherOther What are some of the Meeting Planner's Requirements? Agreement (contract(s)) Article Reprints Audio cassette demo Audio/Visual needs Bio sheet Camera ready flyer Fee Schedule Food/Beverage Handouts Hotel Introductory Sheet Marketing Kit Media Kit Name of speakers program(s) Permission & Arrangements for Back-of-Room Sales Permission from speaker or entertainer to audio tape program Permission from speaker or entertainer to video tape program Photo opportunity Press Kit Title of speaker(s) program(s) Travel Policy/Land & Air Video tape demo OtherOther What support materials are expected from the meeting planner? Audio/visual equipment Banners Blackboard/chalk Blank tapes Chair Clock Computer: hardware Computer: software Dance floor Decorations Drapes, background Easels Flipchart/markers Grease board/markers Head table High chair Interpretation Laser pointer Lavaliere (clip on) wireless microphone LCD Projector/Screen Lighting Lighting/Spots Markers Microphone Music/Sound Overhead Projector/Screen Platform Podium Podium Mike Power Projector Raised platform Remote Mouse Screen Slide projector 35mm Slide Projector/Screen Stand Speaker audio system Speaker phone Stage Stand Stool Table Video / Monitor Video player VCR Video projector OtherOther What are your organization's policy regarding Back of the Room Sales? Permission for Back of the Room Sales: Not Allowed Audio's Books CDs Consulting Educational Videos Manuals Newsletters Software Programs Seminars Training Materials T Shirts/Hats Videos OtherOther Questions / Comments / Purpose of the event(s): reCAPTCHA Submit If you are human, leave this field blank.