Pre Program Questionnaire

Nathalie W. Herrman

Pre-Program Questionnaire

So that Nathalie can best serve you, please fill out the form below (we've kept it as simple as possible), or call 248-207-7293 if you prefer to have a conversation.

Thank you!

KeynoteBreakout sessionWorkshop

Program date:

Program start time:

Program end time:

Site Name:

Site Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Nearest airport:

Name of organization (if different from site name):

Organization Address (if different from site address):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Primary contact:

Phone Number

Email

Organization Mission Statement and/or Core values:

Greatest Successes? (first thought response)

Current challenges? (first thought response)

Important things speaker should know?

Topics to be avoided?

Meeting theme, if applicable:

What happens before Nathalie's presentation?

What do you want participants to take away?

YesNoMaybeMake available for purchase back of the room

Anything else?

Thank you for your time!

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