Company/Organization:

Contact Name:(first & last) Mr Mrs Ms

Phone Number:

Fax Number:

E-mail Address:

What is the meeting theme?

When the participants leave the program, what 3 ideas, skills or concepts should they have acquired as a result of the program?
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What are some challenges, currently or on the horizon, in your organization/industry? (i.e. mergers, downsizing)

Please list the names, phone numbers & e-mail addresses of 3 key individuals who should be consulted in tailoring a program.

Name 1:
Phone 1:
Email 1 :

Name 2:
Phone 2:
Email 2 :

Name 3:
Phone 3:
Email 3 :

To which professional associations does your organization belong?

What is your organization's web address?

What can Wayne do to best meet your organization's needs and objectives?