Pre-Event Questionnaire Note: This form should be completed only after you have a fully executed letter of agreement with Dr. Gustavo. In order for Dr. Gustavo to work most effectively with you at your meeting/program/event, we request that you complete the following form. The information collected serves to customize the presentation and ensure your needs are met. When you engage us, we become part of your team! Please answer all the questions as completely as possible. Please use N/A for questions that you believe do not apply and TBD for items that have not yet been determined. Thank you.Organization and DateOrganization Name*Requested Date(s)Contact Information of RegistrantRegistrant Contact Name* First Last Registrant Contact Email* Registrant Contact Phone*Are you the primary contact person for this event?*Yes, I am the contact person for this event.No, another individual will be the contact person for this event.Event Contact InformationEvent Contact Name* First Last Event Contact Email* Event Contact Phone*Contract, Invoice, and Document InformationHave you received a fully executed contract from Dr. Gustavo?*YesNoYou're not ready to fill out this form yet! To complete this form, you must first have a fully executed contract with Dr. Gustavo. To contact Dr. Gustavo and obtain a contract, please head to the Contact page. Thank you!Have you received an invoice for the initial deposit for the program from Dr. Gustavo?YesNoHave you received a copy of a W-9 from Dr. Gustavo?YesNoAbout the EventType of meeting/program/event:Does this meeting/program/event have a theme?YesNoIf Yes, please explain:*Are there other events where you would like Dr. Gustavo to be present? If yes, enter a maximum of 2:ReceptionWhereWhen Location of this meeting/program/event:What are the specific goals of this meeting? How will we know that the meeting has been a success? How do we want attendees to think/feel/behave differently after the presentation?As per your discussion with Dr. Gustavo, the presentation you have selected is:Culture Trumps Everything (Organizational Culture)Ready or Not, Here They Come (Gen Y/Millenials)Helping Gen Y Succeed (For Gen Ys in Established Culture)You have requested that Dr. Gustavo offer a program in the following format:Keynote (up to 2 hours)Half-Day (up to 3.5 hours)Full-Day (up to 6 hours)Multi-Day (fully customized)Would you like Dr. Gustavo to professionally produce the handouts for the presentation (billed at cost, with no mark up) or would you like to produce the handouts yourself (PDF file provided)?I would like Dr. Gustavo to produce handouts.I will produce my own handouts with the PDF provided by Dr. Gustavo.What is planned immediately before and after Dr. Gustavo's presentation?Before presentation:After presentation:Will there be a break preceding or following Dr. Gustavo's presentation?PrecedingFollowingBothIf Preceding:*Approximate TimeLength If Following:*Approximate TimeLength Please list the names of three senior level people and their position titles from the organization who will be attending the meeting/program/event:NamePosition Audience Demographics (Approximate)Number attending:Percent male:Percent female:Average age:Gen Y Presentations OnlyApproximate percent of attendees born between 1982-2000:Approximate percent of attendees born between 1925-1945:Approximate percent of attendees born between 1946-1964:Approximate percent of attendees born between 1965-1981:Number of attendees by longevity/seniority of the company (approximate):0-5 years6-10 years11-20 years21+ years What are the primary job responsibilities and titles of the attendees?How do attendees feel how the business has been running in the past 12 months?ExcellentWellFairPoorlyWhat are some of the current challenges in your industry/company and with your people?Who are some of your major/direct competitors (rank if possible)?One Last Thing...I write related topics to my presentations on my blog. Would you like to subscribe to my Culture Trumps Blog?*Yes, I would like to subscribe to the Culture Trumps Blog.No, not at this time.In an effort to understand and know the team and the attendees, please provide any humorous events or anecdotal incidents hat would be understood by the majority of the audience and would not be offensive to any attendees. Feel free to send additional information via email to Dr. Gustavo if you think of a story after completing this form or would like to discuss this questions with others and compile everyone’s ideas. Finally, in getting to know your organization/association, it would be helpful to Dr. Gustavo if you would send some descriptive literature (i.e., Annual report, mission statement, core values, etc.) as well as the brochure or flyer for the meeting/program/event. Thank you for your time, energy, and effort in completing this questionnaire. Dr. Gustavo looks forward to helping you make this meeting a great event for all in attendance.Thank You!PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.