Pre-Program Questionnaire Pre-Program Questionnaire Download this form as a PDF Fields marked with a * are required Date * First Name * Last Name * Phone Number * Email Address * Organization Name * Organization Type * SchoolFor Profit CompanyNon-Profit OrganizationReligious Organization Name of Event * Event Location (please include full address) * Purpose of Event * Date of Event * Time of Event * Total time alloted to Charlie including Q&A time * Question and answer session to be included? * YesNo Time Charlie will be asked to participate * Presentation Theme / Subject (to determine talking points) * Audio / Visual options MicrophoneProjector Will the event be video recorded? * YesNo Payment: What is your budget for Charlie's presentation/appearance? * Does this include travel and lodging expenses? * YesNo Other notes, information, or special request.