Stephen J. Hopson, professional speaker, author, consultant

Adversity speaker, deaf, author, consultant, motivational speaker

Pre-Program Questionnaire

Your Name
Title
Company
Street Address
City
State	Zip Code:
Phone
Fax
Email
Website
Preferred contact time and method?

ABOUT YOUR PROGRAM

Do you have a theme, if so please describe

Why did you choose this theme?

What type of meeting (annual meeting, awards banquet, etc.?)

Who is responsible for calling this meeting? (HR, Sales, Marketing?)
Name:	Title:

Who will be introducing Stephen?
Name:	Title:

Time Stephen's presentation is scheduled to occur? Please feel free to send program agenda via email attachment to stephen@sjhopson.com
Starting:	Ending:
When is the best time for Stephen to review the room setup?

Stephen's attire for the presentation?
Suit and tie Slacks and sport shirt (or client provided "theme shirt")

Stephen's role in the meeting (Keynote Opening / Closing, etc.)

If there will be other speakers participating in this event, please describe.

What did you like/dislike about the performance of other speakers you've had in the past? Why?

Would you like Stephen to provide written materials to reinforce the message after his presentation? Yes No

LOGISTICAL INFORMATION
What is the nearest major airport to the meeting site?
Distance to meeting site?
Miles:	Time:
For transportation from the airport to the meeting site would you prefer: Meet Stephen at the airport. Provide details below:
Have Stephen take a cab? Approximate cost? N/A (Local Meeting) Other

Where will the meeting be held?
Establishment:
Address:
City:
State:
Zip:
Phone #:
FAX#:
Hotel Stephen will be staying, if different from above:

Will this be charged to your master account? Yes No
Confirmation # for the hotel room reservation:
Street Address
Phone

Will you be using Image Magnification (IMAG)? Yes No
Will a video crew be on site? Yes No
If so, what is the:
Company Name
Contact Person
Phone Number

If case of emergency prior to the event, who should Stephen contact?
Name:
Cell Phone:
Business Phone:

If your would like Stephen to participate in a scheduled activity the night prior to the engagement, please note it below and include details for proper dress/attire:

AUDIENCE PROFILE

Number attending?:

Will spouses be invited? Yes No

Male/Female ratio?

Average age of group?

Job Titles:

Is there a specific group within this audience that Stephen should target his presentation to?

ABOUT YOUR MANAGEMENT
President/Exec. Director:
Name
Email Address
VP of Sales/Marketing:
Name
Email Address
Sales Training Manager:
Name
Email Address
Other Manager:
Name:
Email Address

GENERAL BACKGROUND INFORMATION

Your Industry:

Main things Stephen should know about your group:

Which target markets/industries does your organization primarily focus?

What is the primary product/service that you sell?

Who are your major competitors?

Any additional comments or information that would be helpful in tailoring this presentation for your group? Thank you.

Meeting Planners:

Pre-Program Questionnaire Room Setup Speaker Introduction Travel Information Schedule Stephen Why Hire Stephen Frequently Asked Questions Speaking Fees Downloadable Pics Stephen in the Media

Obstacle Illusions - Stephen J. Hopson - 1635 Hampton Knoll Drive Akron, Ohio 44313

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