Pre Program Questionnaire

The following information will help Sharon customize her presentation to fit your audiences biggest needs. Please fill out the information and email back to: sharon@sharonlipinski.com
Organization Information
Name of Client or Group
Client Website
Main Contact
Main Contact Phone
Main Contact Email
List 3 company or association values/principles:
1.
2.
3.
Program Information
Program Theme
Date of Event

MonthDayYear
Date
Sharon's Presentation Topic(s)
Sharon's Start Time and End Time
Meeting Start Time and End Time
Purpose of Event
Event Registration or Website Link:
Who will introduce Sharon:
Email address to send introduction to:
example@example.com
What is happening immediately before and after Sharon's Presentation:
Meeting Attire:
What is the stage background color?
What is the room setup/table setup?
When is the best day/time for Sharon to do an A/V check?
List other speakers & their presentations that will be at this event or event webpage listing all speakers & topics:
List 3 adjectives to describe past speakers that have been a big hit with your group:
1.
2.
3.
List 3 objectives for Sharon’s presentation(s):
1.
2.
3.
Audience Information
# of Attendees expected to attend:
Average Age:
Female %:
Male %:
What are the job responsibilities of those in the audience and what are their titles
What are some of the biggest challenges your audience members are facing & where are the opportunities for improvement in their work performance or personal lives
List 3 KEY people, with phone # & email that Sharon can interview within your company: (If applicable)
1.
2.
3.
List any taboo topics that Sharon should steer clear of with your audience:
What else do I need to know to WOW your audience?
Logistics
Event Location:
Event Address:
Event Meeting Room:
Event Location Phone #:
Hotel Name (If different from Event location):
Hotel Address:
Hotel Phone #:
Hotel Confirmation #:
(If reserving a hotel for Sharon, please reserve a king bed & non-smoking room
Will you be billing hotel room to master account?
Nearest major airport to meeting site:
Airport to Hotel Transportation Information:
If someone is meeting Sharon at airport, what is their name & phone #:
Any suggestions on how Sharon can make this event even better for you?
How did you hear about Sharon
Clients often purchase Sharon’s Habit Challenge Mobile App to extend the value of her presentation. Would you like to discuss what your discount would be on this option?

YesNo
Pre-Order Sharon’s Book For Your Group at a Discounted Rate!
Please send all correspondence to

Email: sharon@sharonlipinski.com

Sharon Lipinski

Email: sharon@sharonlipinski.com

4513 Sangamore Rd B1

Bethesda, MD 20816

Phone: 970-581-7681
Please feel free to use the links below on your website to introduce Sharon to your audience.

WEBSITE: http://sharonlipinski.com

BOOKS: http://sharonlipinski.com/book

FACEBOOK: https://www.facebook.com/SharonLipinskiSpeaker/

TWITTER: https://twitter.com/SharonHabitHero

LINKEDIN: https://www.linkedin.com/in/sharon-lipinski-863011a2/
Thank you for taking time out of your schedule to help Sharon customize her program for your audience! We look forward to providing you with an amazing presentation for your meeting!!!
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Organization Information

Program Information

Audience Information

Logistics

Pre-Order Sharon’s Book For Your Group at a Discounted Rate!