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