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Mark Scharenbroich | Keynote Speaker
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  Pre-Program Questionnaire    
  Please complete this form to help Mark do his absolute best to prepare for your event. If you prefer to discuss some of the items in a conference call, please write “call me” in that space.  
 
To get started, please answer this secret question (Required. It confirms that you are a real, live person and not a SPAM robot filling out this form.)
Secret Question:
 What comes out of a toaster? (Hint: it starts with a "T")
Name
Title
Company
Phone
E-mail
Website
Fax

Program
What is your program theme?
What are the objectives for your event? 
What three outcomes would you have for Mark’s presentation?
1.
2.
3.
Which company executives will be speaking before Mark?
 
Who spoke at your meeting last year?
What kind of meeting is it (annual meeting, awards banquet, etc.)? 
Who is responsible for the meeting?
Name
Title
Onsite contact person
Mobile number
Emergency
phone number
Date your meeting begins
 
Date your meeting ends
 
Exact time of Mark Scharenbroich’s presentation
Starting 
 Ending
* Please attach program agenda.
Background Information
What are the current challenges of your organization?
 
What are your points of pride?
 
What are three things Mark should know about your group?
1.
2.
3.
Is there specific jargon Mark should be familiar with (e.g., acronyms)?
 
Who are your target markets?
 
What is the primary product/service that you sell?
 
Who are your competitors?
 
Audience
Number of attendees
Spouses invited?
Yes No      
% of Males
% of Females
   
Average age of group
      
Job titles
Travel Information
Major airport nearest to the meeting
 
Exact location of the meeting
Name of Venue
Address
City
State
Zip
 
Venue Phone
Venue Website
Mark’s Hotel/Lodging Information
Name of Establishment
Address
Phone
Confirmation Number
Ground Transportation
 
Car
Taxi
 Shuttle Rental Car
 
Other
Driving distance / driving time from the airport to venue
 
Driving distance from the venue to the hotel
NOTE: Please print a copy of this completed form as a PDF file for your records prior to submitting.
     

Thank you, and well done!

I look forward to working with you and your organization. 

Nice Bike!
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phone: (952) 939-9080
fax: (952) 939-0093
e-mail: Mark@NiceBike.com		 Scharenbroich & Associates
5702 Seven Oaks Court
Minnetonka, MN 55345
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