It is important that Dan receive as much information as possible prior to your event to aid his customization of your program. Please complete this form and submit it as soon as possible.
How did you hear about Dan Thurmon? (check any that apply) Heard Dan speak beforeWord of mouthSpeakers BureauWebsiteSocial MediaDan’s book, Off Balance On PurposeReferral from another speaker
Any additional details?
What prompted you to choose/hire Dan Thurmon? (check any that apply) Demonstrated ExpertiseBureau RecommendationVideo PreviewPreviewed Dan at another eventHired Dan in the pastOther
Title of your event?
Date(s) of your event: Single dayMulti-day event
Date of Dan’s presentation:
Exact time of Dan’s presentation:
What takes place immediately before Dan’s presentation?
What takes place immediately following Dan’s presentation?
Dan’s role in program (opening or closing keynote, luncheon speaker, etc.):
Any other functions (meals, etc.) Dan is required or invited to attend?
Will someone be introducing Dan?
Appropriate attire for Dan?
Are there and concerns about the technical requirements?
Who is in charge of providing the audio/visual requirements and room set up?
What time will the room be available for an A/V check or a rehearsal?
Who spoke at this meeting last year?
Will there be other speakers at this event?
Meeting facility, location, room:
Shipping Information for the Venue:
Hotel Accommodations (If Dan’s presentation is at a hotel, please book his room at the same property):
Names and titles of any CEOs, executives or VIPs Dan should be familiar with?
What individuals can Dan reference specifically? Their titles, how will everyone know them, and what information about them is common knowledge?
What other information should Dan know about the audience?
Please provide a brief description/profile of your organization (or a link to where this can be found online):
What phrase best characterizes your event? Annual MeetingAnnual ConferenceCustomer MeetingStrategic PlanningEducation Conference/MeetingNew DirectionConventionOther
What is your organization most proud of?
Biggest opportunities present and/or future?
Current challenges/problems experienced in your industry?
Who are your biggest competitors?
Any key phrases or jargon your organization uses often?
Theme of the event?
What are the major objectives/purpose of this event?
What goals do you wish to accomplish using Dan’s presentation?
Are there any sensitive topics that should be avoided?
Any other information that would be helpful to Dan’s program?
Motivation Works, Inc.
2134 North Road
Snellville, GA 30078
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