Pre-Questionnaire

LORI L HAYES

Home
Keynote
Workshops
About Lori
- What Are People Saying?
Contact Lori
Press Kit

Home
Keynote
Workshops
About Lori
- What Are People Saying?
Contact Lori
Press Kit

Pre-Questionnaire

* Indicates required field

Organization *

Please specify organization type (i.e student council, NHS, etc) *

Conference Theme *

Conference Website *

Contact Person *

First

Last

Email *

Phone Number *

Mailing Address *

Line 1

Line 2

City

State

Zip Code

Country

Closest Airport *

Distance From Airport *

Conference Address If different then mailing address *

Line 1

Line 2

City

State

Zip Code

Country

Conference Hotel *

Line 1

Line 2

City

State

Zip Code

Country

Dress Code *

Casual (Jeans) Business Casual (Business Attire) Formal Other

Technology Assessment

Sound Technician *

Yes NO

WiFi *

Yes No

Projector Screen *

Yes No

Mircrophone *

Handheld Cordless Handheld Lavlier Other

Please specify other *

Presentation Request

Day of the Week *

Requested Date *

Start Time *

End Time *

Presentation Request *

Audience *

Other *

Age range of attendees *

# of Participants *

Presentation Facility *

Day of the Week *

Requested Date *

Start Time *

End Time *

Additional Presentation Request

Select One *

Other *

Age Range of Attendees *

# of Participants *

Presentation Facility *

Are there any pre-meeting engagements (i.e. breakfast or lunch)? *

YES NO

Please provide time, location and type for pre-meeting. *

Presentation Goals

What is the purpose of the event? *

Are there any sensitive topics that Lori L should not speak on? *

"At the conclusion of the event I would like participants to..." *

Please provide any additional information you would like Lori L to know prior to your assembly/ event. *

Budget Allocated for Speaker *

Submit