After you have confirmed Jolene as a speaker for your event please print this form and complete with details known at this time.

Fax (319)643-5541

or mail:

Jolene Brown, CSP
1636 Eureka Ave.
West Branch, IA 52358

Name of Contact: _______________________

Position: ______________________________

Sponsoring group: ______________________

Mailing address:
                 ________________________
                 ________________________
                 ________________________
                 ________________________

Phone:_______________
Fax:_________________
E-mail:_______________
Web site:____________________

Event:_______________________

Date of event:________________________

Meeting Location: _______________________

Approximate size of audience: ___________

Audience description: ________________________________________

Theme for your event: _______________________________________

_______________________________________________________________________________

Share your answers with Jolene

• What are the job responsibilities of those attending?

   

• What is the audience mix? (age and education range, cultures, special needs)

   

• Why do people attend this meeting? (expected benefits by those attending?)

   

• What do you want to have happen as a result of my presentations?

   

• What is currently happening in your organization or business that we can celebrate? (What are we doing well?)

   

• What is it that gives those attending headaches, concerns or complaints?

   

• What changes are happening or do you see coming for those in your organization or business?

   

• What other topics are being covered at this meeting and by whom? (send conference agenda)

   

• Is this an annual event? Do the participants know each other?

   

• Any special concerns or problems that I might need to know about? Hot topic issues? Issues to avoid?