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For Meeting Planners

Please complete this form and click the "Send" button to help Dr. Young prepare the best possible program for you. Or, you may print it and fax it to (757) 624-1755. If some answers are unknown, just leave them blank and we'll fill them in later.

Thanks, Doris


Your Meeting Contact Information
Name of Meeting Planner Executive:
Association/Company Name:
Address:
Additional Address:
City:
State/Province:
Zip/Postal Code:
Country:
Phone:
Fax:
E-Mail:
Website:
Other contact in case meeting planner is unavailable or in an emergency.
Name
Phone:
E-Mail:

Your Program
What is your Program Theme?
What does the theme mean to your group?
Who will introduce Dr. Young?
Has the introducer a title?
Introducer's personal E-Mail address:

Meeting Logistics
When are the best times for Dr. Young to do A/V and Room Check?

First Choice:

Second Choice:

What is the dress for your event?





What is Dr. Young's position in the program?


What other Professional Speakers are on the Program?

Speaker 1:
Day:
Speaker 2:
Day:

What Professional Speakers have you used in the Past? Speaker:  Year:
Speaker:  Year:
Speaker:  Year:
What specifically worked well about their performance?
What did not work well?

Expectations
List two major results you would like to achive from your conference:
1
2
What two major results would you like to achieve from Dr. Young's program?
1
2
What would make Dr. Young's program truly outstanding for you?

Meeting Information
Your Conference Dates:
Date of Dr. Young's Program:
Exact time of Dr. Young's presentation:

Start:   End: 
Start:   End: 

Where, exactly, will Dr. Young's program be held? Hotel/Conf Ctr
Meeting Room
Address
City
State/Province
Zip/Postal Code
Phone
Fax
What awards or announcements are there during your event?
Will there be a meal served before or during Dr. Young's Program?
Yes     No  
Will there be an open bar before Dr. Young's Program?
Yes     No  
Will a video crew be on site?
Yes     No  
If "Yes", please provide Company Name    
Company Contact  
Phone Number      
E-Mail 

Travel
What is the nearest major airport to the meeting site?
Distance to the meeting site
Miles         Time     
Who do you wish to coordinate travel plans?
Dr. Young's Office     Your Office  

Audience
How many will attend? Total    % Male    % Female   Avg Age 
Positions & Occupations

% Staff/Line  Describe:
% Management     Describe:
% Directors     Describe:
Are Spouses Invited?
Yes     No  
Do you require a translator?
Yes     No  
If Yes, contact information for translators Name(s)  
E-Mail  
Toward which group should Dr. Young primarily direct her presentation?
Names and positions of senior level personnel attending: Name  
Title     
Name  
Title     

General Background
What have been recent traumatic incidents (last 6 months?
What are the three most important facts Dr. Young should know about your organization? 1.  
2.  
3.  
Is there any jargon with which Dr. Young should be familiar? (i.e. acronyms or titles)
Who are your three major competitors? 1.   
2.   
3.   
Are there any additional comments or information that would be helpful in tailoring her presentation to your group?
Please list three persons who represent the typical audience member, with whom Dr. Young may speak in advance.
1. Name

E-Mail

Phone


2. Name

E-Mail

Phone


3. Name

E-Mail

Phone


Please send Dr. Young the following information:
  1. Annual Report
  2. Newsletter
  3. Marketing Brochures (products, services, etc.)
  4. Mission Statement
  5. Organization Chart
  6. Promotional materials, memos etc for this program including conference brochure.
  7. New employee/member orientation package
  8. Anything else that can give Dr. Young an inside picture of the organization.

If possible, please furnish Dr. Young with the logo, nameplate or program theme in a format suitable for reproduction on a handout and/or presentation. (PowerPoint template, GIF, JPG)

          

Mail to:
Doris Young Associates
320 Westover Ave
Norfolk, VA 23507-1846

or Fax to:
(757) 624-1755

 

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