Rich Fettke

Rich Fettke

Now that you've booked Rich Fettke, we want to help make your event as successful as possible. Please let us know more about your audience and your goals with Rich's presentation. Take a few moments to answer the questions below. If there are questions you can't answer right now, don't worry about it. After we receive your completed form, Rich will contact you by phone to finalize any details and to answer any questions you might have.

Organization/Association name:

Meeting Planner/Contact name:

Title:

E-mail:

Mailing address:

City:

State:

ZIP:

Phone:

Ext.

Fax:

Mobile Phone:

Web site:

Date(s) for Rich's program:
Presentation start time:	a.m. p.m.
Duration:	minutes

What happens just before Rich speaks?

What happens just after Rich speaks?

Facility:
Phone number:
Event Room:
Address:
City:
State:
ZIP:
Onsite Contact:

Appropriate attire for Rich:

Casual Business Casual Business Very Formal

Who will introduce Rich?
Title:
Phone:
Email:

Room Requirements: Non-smoking. Please make a reservation at a hotel that is convenient to your event and confirm for late arrival.

Lodging will be direct billed to master account: Yes No

Meals will be direct billed to master account: Yes No

Lodging same as presentation location:
(if “yes” skip below) Yes No

Hotel name:

Address:

Phone:

Confirmation #:

Rich will make his own travel arrangements and provide you with a copy of his itinerary prior to your event. Travel arrangements will be made only after receiving this completed form.

What airport is closest to the program site?
What other airport (if any) should be considered?

Number of miles from airport to hotel:

Number of miles from hotel to venue:

Ground transportation: Rich will use a cab or rental car unless other arrangements have been made in advance.

How will the room be arranged for Rich’s presentation?

Rounds

Theatre

Other

Please refer to the Audio Spec sheet provided. Unless other arrangements have been made, please provide the name of an audio contact person. Rich will need to give them a call to discuss details.

Name:		Company:
Phone number:		Fax number:
Cell phone:		Email:

Time that room will be empty and available for sound check.
a.m. p.m.

Program title you have selected:

Take The Leap
Getting & Staying Focused
The Courage for Change

Will Rich's presentation be audio or video taped?

Yes

(The section is optional, but it will assist Rich in tailoring his program for your group.)

1.	What is Rich's role in the event? (Opening or Closing Keynote, Luncheon Speaker etc.)

2.	What other speakers will be presenting at this event?

3.	What is the purpose of your event?
4.	What is the purpose of Rich's presentation?

5.	What would cause you to say "WOW...that's just what I wanted to happen!

6.	What is the theme of your event?

7.	How does this theme relate to the outcomes you hope to achieve from this event?

How many will be attending the overall event?

How many will be attending Rich’s presentation?

(Total number)
% Women
% Men
Age range of attendees

Will spouses be attending? yes no

10.

Who will be attending (job titles and job responsibilities)?

11.	What separates your high-performing people from the others?

12.	What is the biggest challenge or fear facing your people?

13.	What are some recent victories?

14.	Who was the previous speaker for this group last year?
	What was their topic?

Please email (Rich@Fettke.com) or fax (925-945-1186)
a complete agenda of your conference/event.

When would it be convenient for Rich to talk with you (via phone) about his presentation?

Date:
Time of day:

This form was completed by:
Date completed:

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