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Thank you for considering The Strength Coach to be a speaker at your upcoming event. In order for him to help you reach your goals, please complete the following form. With this information, The Strength Coach can carry out a plan -- relevant for your function and ready to pump up your audience.

Company:

Web site:

Title of event:

Street address:

City:

State:

Zip code:

Nearest airport:

Date of event:

Presentation time:

Presentation length:

Is the event date: Fixed Flexible

Event organizer:

Phone number:

Fax number:

E-mail address:

Mission statement or slogan:

What specific impact do you want my presentation to have on your audience?

Describe the people who will be in the audience. What is their relationship to your organization and what are their responsibilities? What are their job titles?

Anticipated number of attendees:

Average age of audience:
under 25
26-40
40+

Breakdown of audience gender:
Mostly male
Mostly female
Evenly split

What challenging trends are your colleagues experiencing?

Is attendance required?

What changes would you like attendees to make after this meeting is over?

What did your group like or dislike about previous speakers?

What is in your budget range for a keynote speaker for this event?

How did you learn about The Strength Coach?

Other comments: