The information requested below on this simple form will help Kathy create a great presentation for your upcoming event and will help give Kathy an idea of how to make the most of the time she will be spending with you and your group.

Kathy has spoken at many events. Each one has been different and has had different needs. As she prepares for your program, this information will help her to understand your audience and to customize the program to meet your needs. Will you help in making the program more meaningful for your group by answering the following questions? Thank you!

All fields marked * are required.

About You

Name*:

Organization Name*:

Title*:

E-mail Address*:

Street Address*:

City*:

State/Country*:

Zip/Postal Code*:

Phone*:

Fax:

Website:

Program Request

What Type of Event Are You Planning (i.e. Conference, Training, Banquet, Workshop, etc.)?

Theme of Your Event (if applicable):

Date of Your Event:

Date & Time of PeopleWorks’ Session:

Expected Audience (Total):

Expected Audience (PeopleWorks Session):

 
What are the job titles of the people attending this event?

 
What topics or programs are you interested in?

 
What are 3 important things would you like for us to address in this program?

Customizing the Program

Please provide the following information so we can customize the program to meet your needs specifically.

 
What is the primary product or service you provide?

 
What are 2-3 of the biggest challenges facing your industry today?

 
What are 2-3 of your strengths compared to your competition? What can we congratulate the group for doing?

 
List the name, title, phone number and e-mail of 2-3 people who will be attending so we may call for more information.

Final Request
Please mail, fax, or e-mail us the following information prior to the program:

• Your Mission or Vision Statement
• A Rough or Final Agenda for the Meeting
• A Company or Organization Newsletter

Mail to:
PeopleWorks, Inc.
PO Box 1093
Storm Lake, IA 50588

Fax to:
712.284.2881

E-mail to:
info@peopleworksinc.com