Pre-Program Questionnaire

Thanks so much for hiring Jennifer L. FitzPatrick to speak! In order for Jen to be as prepared as possible to ROCK your event, please complete this form as fully as possible!

Click the button below to start.


Question 1 of 17

Your Name, Title, Contact Information

Question 2 of 17

Please share the purpose of your event (annual meeting, team building, awards event, etc.) and/or any goals you have for the event.

Question 3 of 17

If your conference/meeting has a theme, please let us know what it is.

Question 4 of 17

Time/Date and title of Jen's presentation

Question 5 of 17

Are you planning to record Jen's presentation? Please remember you need to discuss terms ahead of time and Jen must receive a copy of both the unedited footage as well as the final version you will be utilizing.





Question 6 of 17

What will happen before and after Jen's presentation (meals, exhibit halls, other speeches, etc.)?

Question 7 of 17

Who will introduce Jennifer (name/title)?

Question 8 of 17

Please share other speakers who are speaking at the same event and what topics they will be covering.

Question 9 of 17

What would you like your audience to think, feel or do differently after Jen's presentation?

Question 10 of 17

What other speakers have you had for a similar event that you LOVED? Why?

Question 11 of 17

With your permission, Jen would love to talk with two-three of your event planning committee members/leaders at your organization in order to customize the talk for your audience. Please list names, titles and contact information of those individuals.

Question 12 of 17

Tell us as much as you can about your audience (demographics, occupations, problems they want to solve). Also what is the expected size of your audience? This helps Jen customize the program.

Question 13 of 17

Jen's books Reimagining Customer Service in Healthcare and Cruising through Caregiving are great takeaways for your attendees. How would you like to make them available?


Our organization will purchase a set number of books.


We will provide Jen with a list of sponsors/partners to reach out to discuss possible book purchases for our attendees.


We will provide a table for Jen to offer book sales to our attendees.

Question 14 of 17

Please provide the name and cell phone number of Jen's onsite contact at the event.

Question 15 of 17

Please describe the area where Jen will be speaking (large stage? small conference room? room with a stage riser?). How will seats be arranged?

Question 16 of 17

What "VIPs" or special sponsors should Jen be sure to meet?

Question 17 of 17

Anything else you'd like Jen to know?

Confirm and Submit