Pease complete this information to assist Bill in preparing for his presentation with your organization. His office should receive this information a minimum of four weeks prior to the meeting date. After Bill’s review, his office will schedule a tele-conference meeting to discuss it further with the conference team. Thank you for your cooperation with this!

  • Name of Person completing this form:
    • Phone Number:
    • Email:
  • Theme of this event
  • Identify company(s)/organizations in attendance:
  • Audience: [ ] Local [ ] Regional [ ] U.S. Based [ ] Internationall
  • Provide a general work related description of the make-up of the audience.
  • Approximate number of attendees expected:
  • Approximate percentage of men/women expected:
    • % Men:
    • % Women:
  • Approximate number of attendes within the age ranges:
    • Under 30:
    • 30-45:
    • 45-60:
    • Over 60:
  • Will spouses/life partners be in attendance? Yes / No
  • Identify CEO/President/VIP’s in attendance.
  • What is your organization’s mission statement or company philosophy?
  • What is your organization’s vision statement
  • What is the primary business function of this group?
  • Why has this group assembled at this location at this time?
  • Identify accomplishment(s) the group has recently achieved:
  • What are the professional challenges facing the individuals in the audience?
  • What are the significant challenges currently being faced by your industry?
  • Describe the most significant changes this group has experienced during the last twelve months.
  • Provide the specific objectives you desire from my presentation.
  • What is the thrust or message you would like to convey to the group?
  • Identify any sensitive issues you wish Bill Gormont’s presentation to avoid:
  • When Bill Gormont leaves your special event, you will feel he has achieved your goal if he has . . .
  • Identify other speakers presenting at this event:
  • What takes place immediately before and after my program (break, meal, breakout session, another speaker)?
    • Before:
    • After:
  • Name of person introducing Bill:
    • Title:
  • Identify a web site I may visit for further reference work:
  • Identify the individual from your organization who can schedule your committee staff for the teleconference review.
    • Name:
    • Phone Number:
    • Email:
  • Identify any other items of interest you feel may be appropriate to share that could help make this a meaningful event.

This document is also available in PDF format for ease of download and printing. If you don’t already have Adobe Reader, you can use this link to download it now for free.

Pre-Program Questionnaire

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