Einstein Alive, Motivational Speaker, Business Innovation, Arden Bercovitz, Ph.D., CSP, "The Einstein Guy"
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PreProgram Questionnaire
Part 2

Privacy Guarantee: We will not sell, rent, or give away your e-mail address or other personal information without your consent. All information provided in our Pre-Program Questionnaire is kept in strict confidentiality.

Arden Bercovitz, Ph.D., CSP, is looking forward to speaking at your meeting. Arden will portray the historical character of Albert Einstein, and will share new ways of thinking and being more creative. To bring Arden up to speed, he needs your insight and input. Please answer the following as specifically as you can. Your response is confidential. This is your chance to advise Einstein! Thank you.

The Program

1) What is the conference/meeting theme?

2) What would you like "Albert Einstein" to accomplish and is he to be a surprise?

3) What is the specific purpose of this meeting? (Annual event, Awards Banquet, etc.)

4) What are your specific objectives for Arden's presentation? For the entire event?

5) Issues to avoid, if any?

6) What specific issues/topics need to be discussed?

7) If you have already seen Arden live, or seen him on tape, is there a story, an emphasis, a point, a message, that you definately want him to include for your group?

8) What balance do you want between the following areas:
Entertainment: %    Content: %   Inspiration: %

9) What takes place immediately before and after Arden's presentation (lunch, another speaker, etc.)?
Who will introduce Arden?

(We have several excellent introductions for your convenience. Choose the best one from our intro section.

10) Are there any functions preceding Arden's presentation that his presence could enhance?

11) Time of Arden's presentation:
Start:       End:

12) Arden encourages you to professionally audio or videotape his talk for archival purposes. We require a " master copy and a " time coded VHS master copy of unedited footage.

Please remember that you must receive written permission from us to do so. Are you requesting permission now? Or have you already done do?

13) Are there any other major speakers on the program? If so, what are their names, phone numbers, titles, and topics they will be speaking about?

14) Which speakers have you used in the past for a similar event? What worked? What didn't?

15) With your permission, we would like to contact 3 or 4 of your best, your newest, your most experienced people, preferably with different viewpoints.
Phone (W):
Phone (H):
Email address:

Phone (W):
Phone (H):
Email address:

Phone (W):
Phone (H):
Email address:

Phone (W):
Phone (H):
Email address:

Audience Information

1) Number of attendees?
Are spouses invited?
Percentage male/female?
Age range?
Percent Managers or Supervisors?
Income range?
Educational background?
Ethnic make-up?
Disabilities to make allowances for?

2) Who will be attending this evening (executives, managers, employees, clients, community, etc.)?

3) Are there any frictions or factions between them?

4) What are the major job responsibilities of those in the audience?

5) How easily do your people participate in Q&A and interactive programs?

6) What services/products distinguish your business?

7) What are the names, titles, and contact information of your top executives who will be at the meeting?

8) Which key publications do your people read?

9) Which key professional associations are relevant to your people?
Check which you personally belong to?

10) Please take a look at the following quotes. Would you please check which ones are most relevant to this audience?

"CREATIVITY is seeing what others see and thinking what no one else has thought."
"NEVER let yourself be seduced by any problem, no matter how difficult."
"I simply IMAGINE it so, then go about to prove it."
"IMAGINATION is more important than knowledge."
"Have the COURAGE to take your own thoughts seriously, for they shape you."
"Setting an EXAMPLE is not the main means of influencing another, it is the only way."
"Try not to become a person of success, but rather, to become a person of VALUE."
"For me a SIMPLE message, to think and act with courage, independence and imagination."
"The only sure WAY to avoid making mistakes is to have no new ideas."
"The world as WE SEE it is only the world as we see it. Others may see it differently."
"PROBLEMS cannot be solved at the same level of consciousness that created them."
"My only GENIUS talent is inquisitiveness."

11) Please share some humor about your group:

12) Please comment whether we may invite a few potential clients to preview Arden's part of your event?

13) Is there anything else Arden should know about the audience before addressing them?

General Background Information

1) What is your mission statement? Do people know it? How long has it been policy?

2) What are your organization's goals?

3) Please give Arden an overview of the history, hierarchy and role of this organization. What's its track record?)

4) Is there a shared concern by the audience and, if so, what is it?

5) What are your challenges? What needs fixin'? Where are your people stalled, holding back or coasting? Who's responsible, and how/when are changes to be initiated/completed? Is this change urgent?

6) What major changes/trends have recently influenced your group?

7) What new products, policies or strategies are pending? Where are the new opportunities?

8) Who are your major competitors?

9) Where would new thinking, more creativity and wider perspectives be rewarded?

10) How visionary is your leadership and management? Any clear examples?

11) How innovative is your culture - organization - industry? Anything to brag about? Anything to celebrate?

12) Why are/aren't things done differently?

13) What's Hot, What's Not regarding slogans and buzz words?

14) Einstein has a unique ability to "naively" say just what needs to be heard, to challenge just what needs to be thought, nudging nuerons to new heights of imagination. If you could chat with the likes of Albert Einstein, what would you ask him?

15) What else should Arden know that might influence the content and tone of his presentation? How will anyone know that this meeting and Arden's part hit the target?

In addition, please forward any other information reagrding your organization (brochure, annual report, agenda, sales literature, promotional materials, etc.) We would also like to have a digitized copy of your logo and copies of all promotions for this event.


Your name:
Mailing address:
City: State: Zip:
Phones (direct): (home):
Email address:

A copy of this finished form will be emailed to you.
If you have questions, please email or call 760-726-1124

Remember, when your schedule permits, please call our office to set a phone appointment to talk with Arden. He'll understand your group much better through a conversation. Your help is instrumental in shaping Einstein's remarks.

Thank you for your insights, time, and assistance.

Albert Einstein Leadership and Management quotes
"Problems cannot be solved at the same level of consciousness that created them."
Read Leadership and Management Quotes by Einstein...
Anne Tiernan, Exec. Dir., Seattle Federal Executive Board

A glimpse into the great mind of Albert Einstein, and, a fresh look at our industry. Your research was thorough and very much appreciated by our members. A unique opportunity our attendees won't soon forget.
- Russell Lemieux, Exec Dir, Assoc Fund Raisers & Direct Sellers

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