Meeting
Planners

Questionnaire for Meeting Planners

Please take a moment to complete and submit the questionnaire below. We suggest you print a copy for your records.If you have any questions or concerns, please contact us at info@secretan.com or call us at 519-927-5213. We would also like to encourage you to send us your comments after your event by completing the Client Feedback Form in this meeting planner section.

Thank your for your assistance!

Client Contact:

Company:

Office Phone:

Client Contact Name:

Cell Phone:

Title:

Email:

Address:

Fax:

Is this person available to discuss the event objectives and keynote content with Lance by phone?
Yes No

If not, please provide the name and contact information for the appropriate person:

Program Information:

Please select the keynote to be presented at your event:
Event theme and objective:
Audience size:
Audience makeup:
Suggested content to include:
Sensitive issues to avoid:

Event Information:

Venue Name:
Address and Phone number:
Event date:
Audience makeup:
Report to speaking area by:
What precedes Dr. Secretan's presentation:
Name and title of introducer:
Presentation start time:
Presentation end time:
Total presentation time (not including introduction):
What follows Dr. Secretan's presentation?
Will there be a book signing at your event? Yes No
Would you like to purchase products for your event? Yes No Please check out our Estore
Will you be recording this event? Video Audio Both If yes, please consult our office for permission to record the presentation.
Is Dr. Secretan welcome to bring a guest?
If this is a luncheon or dinner event, please note that Dr. Secretan is vegetarian.

A/V Specialist:

A/V Company:
A/V specialist's name:
Office phone:
Cell phone:
Email:
Date of sound check:
Time of sound check:
Have you reviewed the A/V requirement: Yes No click here to view the A/V Requirements
If yes, do you have any questions of concerns about the A/V Requirements? Yes No
How many screens will there be?
Will it be front or rear projection? Front Rear
Name and contact information of on-site liaison:

Event Coordinator:

Event coordinator's contact:
Company:
Client contact name:
Title:
Address:
Office phone:
Cell phone:
Email:
Fax:

Ground Transportation:

Will ground transportation between the airport and the venue be provided? Yes No
Name of transportation service:
Phone number:
Reservation Number:
Meeting Place (i.e. baggage claim area):
Travel time from airport to hotel:

Accommodation:

Hotel Name (if different than event venue):
Hotel Address and Phone number:
Confirmation Number:
Check in date:
Check out date: