Pre-Program Questionnaire

Pre-Program Questionnaire for Nicholas Dillon, The BELIEVE Coach

This pre-program questionnaire is to assist us in helping you make this your greatest event ever. Once completed, return to Nicholas Dillon at If you have any questions, please call directly toll free at (866) 305-9818. Fax # (262)691-4966.

Specific objectives for Nick’s presentation?

How will you measure the success of this event and Nick’s participation?

What topics should be avoided?

Number expected to attend?

% male

% female

Have you used speakers in the past? If so, who? What did you like and dislike about those presentations.

What time frame does the speaker have?

Please provide the required field.

Please check if you are able to provide any of the items listed below.

Please provide the required field.

Completed by:


We look forward to serving your organization!