| Title | |
| First Name | |
| Last Name | |
| Organization Name | |
| Department Name | |
| Address1 | |
| Address 2 | |
| City | |
| State/Province/County | |
| Zip/Post Code | |
| Country | |
| Phone Area Code | |
| Phone Number | |
| Best Time to Call | |
| Fax Number + Area Code | |
| Email Address | |
| Website Address | |
| Check here if you are planning this event for another
organization. Please complete the following two questions | |
| NOTE: We will not contact the sponsor until you direct
us to do so | |
| Name of the event sponsor | |
| Website of the event sponsor | |
| THE PROGRAM | Empty |
| Which of Victoria's topics have you selected? | |
| Is this event a? | |
| Do you have a program theme selected? | |
| If yes, please indicate theme here | |
| What does the theme mean to your group? | |
| What is the purpose of this event? | |
| Summarize the mission/Vision of your organization | |
| What type of business is this? | |
| Please give a brief overview of the type
of products and services that you provide | |
| Is this organization a? | |
| Give a brief overview of the work your
section deals with | |
| Are you located at the organizations headquarters? | |
| How many people in your organization/group? | |
| Number of employees at your site | |
| How many people in the department currently experiencing
changing conditions? | |
| How many departments would you like to effect change
in? | |
| What change are you hoping to effect? | |
| Have there been any minor or major changes
within the organization recently, please explain? | |
| Have you tried to deal with the issues internally? | |
| If yes, what measures have you implemented
and what were the results? | |
| Have you tried to deal with the issues/people externally? | |
| If yes, what were the measures taken and
what were the results? | |
| Has the group experienced any special
success or failure recently, if so, what was it? | |
| Are there any special or sensitive issues
of which Victoria should be aware? | |
| If you have had similar meetings in the
pase, who were the speakers? | |
| What else should Victoria know about your
group and or meeting? | |
| PLEASE SEND ME | |
| Is your inquire for | |
| DATE/TIME | Empty |
| Where and when will the event be held? | |
| What time would you like Victoria to be there? | |
| From what start time to what finish time | |
| Please feel free to enter as much detail
as possible regarding times | |
| Who will be speaking before Victoria? | |
| Who will be speaking after Victoria? | |
| Is Victoria to be the | |
| Is there some one who wants to meet with Victoria | |
| If more than one person, please supply
list of names, we do understand that it is subject to change. | |
| Title | |
| Issues | |
| THE VENUE | Empty |
| Event Location Name | |
| Address 1 | |
| Address 2 | |
| City | |
| State/Province/County | |
| Zip/Post Code | |
| Country | |
| Nearest Cross Street or Corner | |
| Time to Venue from Airport | |
| Contact Person at Location | |
| Contact Phone Number + Area Code | |
| Contact Fax Number + Area Code | |
| Contact Email Address | |
| Type of Facility | |
| Meeting Room Name or Number | |
| Room Set Up | |
| Name of person in charge of Equipment Set Up | |
| Audience Size | |
| Age Range | |
| Will Sponsors be in Attendance? | |
| What type of attire will the group be wearing? | |
| Other Attire - Please explain | |
| What job titles will be represented (Check all that
apply) | |
| Executive | |
| Senior Management | |
| Mid Management | |
| Supervisors | |
| Trainers | |
| Salaried Employees | |
| Hourly Employees | |
| Family & Friends | |
| If Other, please give details | |
| Who will be introducing Victoria? | |
| WHERE WILL VICTORIA BE STAYING | Empty |
| Location Name | |
| Address 1 | |
| Address 2 | |
| City | |
| Nearest Street or Corner | |
| Nearest Airport | |
| Travel Time to and from Airport | |
| Travel Time from Accommodation to Venue | |
| Victoria prefers to be met at the airport by either
a representative of your organization or a Limo Service. Will this be possible | |
| If yes, please specify details here | |
| If no, is the following available? | |
| If Other, please specify details | |
| EMERGENCY PREVENTION | Empty |
| If Victoria should encounter any last minute problems or emergencies
en-route, who should be contacted? | |
| Phone Number + Area Code | |
| Cell Phone Number with all necessary codes | |
| Alternative Phone Number | |
| Venue Phone Number + Area Code | |
| If you have additional information that
you can offer or additional questions you would like to ask please feel free to do so | |
| CONFIDENTIAL, PRIVATE COACHING CLIENTELE ONLY: | Empty |
| All information with an * is necessary for client assessment | Empty |
| * Expectations of the Private Coaching System | |
| * Position | |
| * Name | |
| * Contact Phone Number + Area Code | |
| * Alternative Contact Phone Number | |
| * Preferred Email Address | |
| Optional - Website Address | |
| * Goals | |
| The following are optional | Empty |
| Issues you would like to work on | |
| If you have selected Other, please specify | |
| List Dreams, Desires, Aspirations | |
| What type of person would you like to
become if you could? | |
| How would you like to be perceived? | |
| List your most important long and short
term goal | |
| * Please complete the following. How would
you like us to assist you? | |
| How do you learn best? | |
| If other, please explain | |
| |
