MetaMatrix Consulting Group Inc.

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" I am sending you the name of a speaker that I observed as a
keynote speaker at the Alaska MGMA meeting this last year. I was very impressed and he did an outstanding job. I know that is hard to fine new talent for our speakers year after year.

John W. Houser
Medical Group Management Association

Pre-Questionnaire

This form has been created to help David Goldsmith in the preparation of a presentation that fits your event. It is to be used after booking an engagement and setting a date. If you have any further questions please feel free to call (888) 777-8857. Thank you for putting your confidence in us.

Please send us the following information as soon as available:

Newsletters directed to employees or customers
Company brochures
Annual report
Employee brochures
Invitation and / or announcement events package.
Hotel or facilities information
Organisational charts and alphabetical listing of attendees.

*Mandatory fields

Your Name:

Title:

Company / Organisation:

Address:

City:

State / Zip:

Country:

Phone & Extension:

Fax:

Email Address:

Do you have a URL:

http://

Meeting Planner's Name:

Title:

Phone & Extension:

Fax:

Email Address:

What are your companies main product lines and how are you perceived in the market place?

What is the title of
the meeting?

What is the theme of
the meeting?

What other events or presentations will set the tone for the event?

Please confirm the exact
date and time David will
speak

Arrival Date:

Starting Time:

Ending Time:

Departure Time:

Who will introduce David:

What activities will precede David's presentation:

What activities will follow David's presentation:

Expected Number of
attendees:

What type of work do the attendees perform:

David would like to talk to at least 5 and up to 7 members of the audience as he develops his presentation:

Contact #1

Name:

Title:

Company / Organisations:

Address:

City:

State / Zip:

Phone & Extension:

Fax:

Email Address:

Contact #2

Name:

Title:

Company / Organisations:

Address:

City:

State / Zip:

Phone & Extension:

Fax:

Email Address:

Contact #3

Name:

Title:

Company / Organisations:

Address:

City:

State / Zip:

Phone & Extension:

Fax:

Email Address:

Contact #4

Name:

Title:

Company / Organisations:

Address:

City:

State / Zip:

Phone & Extension:

Fax:

Email Address:

Contact #5

Name:

Title:

Company / Organisations:

Address:

City:

State / Zip:

Phone & Extension:

Fax:

Email Address:

What would you consider to be a successful presentation? Results?

Objective #1

Objective #2

Has their been any important events in the past few months that might effect the audience either positively or negatively?

Are there any additional comment that David should be aware of prior to speaking?

Thank you for taking the time to complete the questionnaire. The information is helpful to insure that we can meet and if possible exceed your expectations. Please feel free to call our office at any time for further information or to clarify any matter.



	©2003 Copyright MetaMatrix Consulting Group, LLC. All Rights Reserved. 8248 Barksdale Lane Manlius, NY 13104 Phone: +1 (315) 682-3157 (888) 777-8857 Fax: +1 (315) 682-0509 Email: info@davidgoldsmith.com