Pre-Program Questionnaire

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The Path of the Genie - Your Journey to Your Heart’s Desire

Pre-Program Questionnaire

To help Dr. Dilip Abayasekara customize his presentation for your group,
please fill out as much of this Pre-Program Questionnaire as possible.

Best time for Dr. Abayasekara to reach you (Mon - Fri)
From		To


Specific purpose of this meeting (award banquet, anniversary, celebration, annual conference, etc.)


What is the program theme?


Specific objectives you desire from Dr. Abayasekara's presentation?


Who is responsible for calling the meeting?
Name
Title

What is the name and title of Dr. Abayasekara's introducer?
Name
Title
Time frames for Dr Abayasekara's presentation?
Start
End

What is on the program just before Dr. Abayasekara speaks?


What is on the program just after Dr. Abayasekara speaks?

Appropriate Dress Code for the meeting?
	Tuxedo
	Suit & Tie
	Slacks & sport shirt
	Client provided "Theme shirt"

Who are the other speakers on the program?
Name
Topic

Name
Topic

Name
Topic

What did you like and/or dislike about previous presentations given at meetings such as this for your group?
Liked
Disliked
What would make Dr. Abayasekara's presentation really special for your group?


Will Dr. Abayasekara's presentation be taped?
	Yes No

If so, name the recording company, and provide their contact information.
Company
Phone
Contact Person

To reinforce the impact of Dr. Dilip Abayasekara's ideas after his presentation, would you like information about how he can make his learning materials available?
	Yes No

The Audience
Number expected?
Male/Female ratio?
Age range?
Will Spouses be attending?	Yes No
Educational background
Income range

Major job responsibilities of the audience
Problems/challenges?

Breakthroughs/milestones?

What separates your high performance people from others?

Mission of your organization

Vision of your organization

Travel Information - Venue
Name of hotel/conference site
Street Address
City
State
Country
Nearest Airport
How will Dr. Abayasekara be transported from the airport to the meeting site?
	Will be picked up by

Phone number of person above

	Taxi Cab: approx. fair

In Case Of Emergency
Whom should Dr. Abayasekara contact in case of emergency?
Name
Phone (Day)
Phone (Evening)

Referral Source
How you found Dr. Dilip Abayasekara
	Heard Dr. Dilip speak
	Read an article by or about Dr. Dilip
	Personal contact with Dr. Dilip
	Referral
	National Speakers Association
	Liberty Bell Speakers Association
	International Speakers Network
	Toastmasters International
	Web Surfing
	Other
	Describe

Dilip Abayasekara, Ph.D., A.S. | Mailing Address: Dr Dilip, PO Box 405, Enola, PA 17025
Phone: 717.728.2203 | Cell: 717.648.1080 | Fax: 717.728.2296