EVENT INTAKE FORM

C3 Financial Services ● 130 Oakhaven Drive ● Wexford, PA 15090
Email address *
CONTACT
Organization’s Name *
Your answer
Organization’s Address
Your answer
Contact Person for this Event
Your answer
Contact Person's Title
Your answer
Office Phone
Your answer
Cell Phone
Your answer
Email
Your answer
Fax *
Your answer
NOTE: Carl will use the cell phone listed above during his travel to your event.
NOTE: To contact Carl during his travel to your event, please call 571-422-9776.
TRAVEL
1. What are the airports for Carl to consider when flying to this event?
Your answer
Is there one airport that you would recommend over the others?
Your answer
NOTE: Carl flies from Pittsburgh International Airport
2. Will someone pick Carl up from the airport or would you rather have him rent a car or take a taxi?
Your answer
3. The only travel expense your organization is contractually required to arrange and cover is lodging. What is the name, phone number, and address of where Carl will be staying?
Your answer
What is the confirmation number for his room?
Your answer
SHIPPING
1. If we decide to ship product, where is the best place to send it? Your Organization, Event Conference Center, or Hotel?
Your answer
Shipping Address
Your answer
Attention (person or department)
Your answer
2. Ideal arrival date of packages?
MM
/
DD
/
YYYY
EVENT LOGISTICS
1. Where will Carl be speaking? Exact name of the location where Carl will be presenting:
Your answer
Complete address of the location where Carl will be presenting:
Your answer
Phone number of the location where Carl will be presenting:
Your answer
2. What are the dates of your entire event?
Your answer
Date and time of Opening Session?
Your answer
Date and time of Closing Session?
Your answer
Date(s) Carl needs to be at the event?
Your answer
Webpage with event details (i.e. theme, schedule, etc.)?
Your answer
3. Is there a dress code or guidelines for appropriate attire?
Your answer
4. Time frame of Carl’s session(s)? Session One: Date
MM
/
DD
/
YYYY
Start Time
Time
:
End Time
Time
:
Amount of time allotted for Carl’s presentation
Your answer
Session Two: Date
MM
/
DD
/
YYYY
Start Time
Time
:
End Time
Time
:
Amount of time allotted for Carl’s presentation
Your answer
Session Three: Date
MM
/
DD
/
YYYY
Start Time
Time
:
End Time
Time
:
Amount of time allotted for Carl’s presentation
Your answer
Session Four: Date
MM
/
DD
/
YYYY
Start Time
Time
:
End Time
Time
:
Amount of time allotted for Carl’s presentation
Your answer
THE AUDIENCE
1. Number attending
Your answer
2. Range of ages
Your answer
3. Average age of group
Your answer
4. Percentage of males
Your answer
Percentage of females
Your answer
5. Educational background
Your answer
6. What are the major roles and/or responsibilities of the audience?
Your answer
CREATING A WINNING PROGRAM
1. What is the theme of your event?
Your answer
2. Imagine you have a blank sheet of paper and you could create an ideal conference by just writing words. What would you write? What are 2-3 big goals you want to achieve during your entire event to empower your attendees to achieve financial wellness?
Your answer
3. What is the specific purpose of the session(s) at which you are asking Carl to present (training, competition, awards, annual meeting, etc.)?
Your answer
What specific outcomes do you want Carl to achieve with his presentation(s) that will assist you in achieving your goals for your event?
Your answer
Are there any sensitive issues that should be avoided?
Your answer
4. Are there any specific problems or challenges your organization is facing that you want Carl to address if it fits into his presentation(s)?
Your answer
5. Are there any positive opportunities your organization is experiencing (or close to experiencing) that you want Carl to address if it fits into his presentation(s)?
Your answer
6. What specific characteristics/behaviors are you looking to champion with your members? In other words, what characteristics/behaviors separate your people from others in your organization?
Your answer
7. Any other suggestions to help Carl make this program your best ever?
Your answer
Thank you for sharing your responses on this Intake Form. This information will help Carl design programs that fit your event goals and desires!
C3 Financial Services ● 130 Oakhaven Drive ● Wexford, PA 15090
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service