Please take a moment to complete the items below.  Please call us if you have any questions. There are buttons for PDF downloads and printing at the top-right area of this questionnaire. Thank you.

 Name:  _____________________________________________________________________
 Title:            _____________________________________________________________________
 Company:  _____________________________________________________________________
 Address:  _____________________________________________________________________
           _________________________    __________________________________________
Phone:          _____________    Fax:  _______________   Email:  __________________________
 
 Title of                                                    Conference
 Program:       _______________________ Facility
                                                Address:        ______________________________
 Show Date:       _______________________
 Time of meeting                                        Phone + Fax:    ______________________________
Dolan's
 Presentation:  _______________________ Length of Program: __________________________
 
 Will ground transportation from airport to hotel and return be provided?  o Yes   o No
 If so, who will pick up ?       ________________________________________________________
 Will non-smoking room reservations be made ?    o Yes   o No    If yes, please indicate date(s).
       Date In:  _________________   Date Out:  __________________
 Hotel Accommodations:  _____________________________________________________________
 Address, Phone    _____________________________________________________________
 Confirmation Number:  _____________________________________________________________
 
Name of actual A / V technician:  _____________________________________________________
                                          Phone:  _________________________
 
 Please check appropriate attire for Mr. Dolan.
 o Suit        o Sport Coat and Tie       o Sport Coat and Sport Shirt        o Sport Shirt and Slacks
 
Is there anyone Paul should talk to about this or other programs ?
 Name:  ___________________________________________________________________________
 Phone Number: ______________
 
 Name of Site Liaison:  _____________________________  On Site Phone: ___________________
 Name and title of program introducer: _________________________________________________
 Theme and objective of event:  _______________________________________________________
 __________________________________________________________________________________
 What is the audience made up of (Sales Agents, CEO's, Clients, etc.? ) _____________________
 __________________________________________________________________________________
 Audience Size: _______________________  Are spouses included ?  o Yes  o No
 What precedes Mr. Dolan's presentation ?  _____________________________________________
 What follows Mr. Dolan's presentation ? _______________________________________________
 Any sensitive issues to avoid with this group ?  o Yes   o No  _____________________________
 __________________________________________________________________________________
 Any special areas to include ?  o Yes   o No  ____________________________________________
 __________________________________________________________________________________
 Any additional comments or suggestions ?  o Yes   o No  ________________________________
 ______________________________________________________________________________
 Name and phone number of contact, in case of emergency, immediately prior to this event:
           Name: ________________________   Phone: _______________________________________
 Can Mr. Dolan bring guests ?  o Yes   o No  _____________________________________________