CONTACT INFORMATION
Contact Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Cell Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Website
*
Name of Organization
*
Type of Organization or business
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How did you hear about Lisa Marie Platske or Upside Thinking, Inc.?
*
Referral
Speaker’s Directory
Website
Other
How did you hear about Lisa Marie Platske or Upside Thinking, Inc.?
*
Please specify exactly where you found us:
Date of meeting:
*
-
Month
-
Day
Year
Date
Type of meeting:
*
Breakfast
Lunch
Dinner
Purpose of meeting:
*
Convention
Corporate
Seminar Event
Other
How often do you hold your meeting:
*
Weekly
Monthly
Yearly
Other
Meeting Location
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PRESENTATION INFORMATION:
Program theme and/or title:
*
Length of the presentation:
*
Specific objective:
*
What is scheduled prior to or immediately after?
*
Budget/Investment
*
Check what will be provided and/or is critical to ensure the success of the presentation:
*
Headset Microphone (preferred by Lisa Marie)
Projector
PowerPoint capability
Other
What would make this presentation exceed the audience’s expectations?
*
THE AUDIENCE:
The number attending:
*
Spouses in attendance:
Yes
No
Percentage of females in audience:
*
Percentage of males in audience:
*
Average age of attendee:
*
Average number of years they have been in the industry:
*
DETAILS ABOUT YOUR AUDIENCE:
Problems? Challenges? Current Issues?
You are...Where you choose to be.
Submit
Should be Empty: