Name of Organization:
Primary Contact Person:
Address:
City:
State:
Zip:
Phone:
E-Mail:
Website:

Your Event

Event Name:
Event Date:
Event Time:

Pre-Event Contact

Contact Prior to Event:
Title:
Office Phone:
Fax:
Mobile:
E-mail:

Onsite Contact

Onsite Contact:
Title:
Office Phone:
Mobile:
What hotel will contact stay at for this event?:
Hotel Phone (if different from below):
Second Onsite Contact (add if same as above):

The Venue

Venue:
Room Name:
Address:
City:
State:
Zip:
Phone:
Fax:
Distance from Airport:
Distance from Hotel (if different):

Hotel

Hotel (if different from the venue):
Address:
City:
State:
Zip:
Reservation Confirmation #:
Distance from the Airport:

Ground Transportation

Ground Transportation Company:
Phone:
Confirmation #:
Location where Michael will be met upon arrival:
What is the exact timetable for Michael?:

Presentation Information

Speech Topic:
Would you like Q & A to follow presentation?:	Yes No
Would you like a book signing to follow the presentation?:	Yes No
Attire:

The Audience

Size of Audience:
%Men:
%Women:
Average Ages:
Spouses:
General Description of Attendees:
Names and titles of any executives or VIPs that Michael should be familiar with?:

The Introduction

Individual Introducing Michael:
Title:
Phone:
E-mail:

Event History and Goals

If there is a theme for the event, what is it?:
Which speakers have previously spoken at this event?:
What is the major objective of this event?:
What are the current challenges and problems in your industry?:
What do you expect for your organization/association in the coming year?:
Are there any sensitive topics to avoid?:
Why did you choose Michael as your speaker?:
If Michael could leave your group with two thoughts, lessons or action steps, what would they be?:
What takes place immediately before and after Michael’s program (meal, break, another session/speaker)?:
Other information:

About You

Who completed this form? (if different from above):
Title:
Phone:
E-mail: