Seminar Evaluation
Date of Seminar
-
Month
-
Day
Year
Date
Please rate the speaker (10 being highest, 1 being lowest)
10 - great speaker
9
8
7
6
5
4
3
2
1 - poor speaker
Comments about speaker / program - improvements, what we can do better, etc.
Would you like a no-obligation meeting with Ted Kuczek to discuss your estate planning?
YES
No
Do you prefer an in-person meeting or a virtual meeting?
In-Person
Virtual
No preference
What time of day is best to contact you?
Morning
Afternoon
When would you like your meeting?
ASAP
Within 2 Weeks
In A Month
After A Month
What time of day would you prefer for your meeting?
9:00 am
12:00 pm
3:00 pm
Your Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
E-mail
*
Current Estate Plan
None
Joint Tenancy
Will
Trust
Land Trust
Power of Attorney - Property
Power of Attorney - Health
Prefer not to answer.
I would like Ted to give a seminar to a group to which I belong.
Yes
No
I would like a seminar packet for a friend / spouse who couldn't attend the seminar.
Yes
No
Other comments
Click the box then press Submit Form. Thank you!
*
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