Pre-Program Questionnaire
For 
Rocky Bleier

It is important that your speaker receive as much information as possible prior to your meeting to aid in their speech preparation.

PLEASE PRINT AND COMPLETE THIS FORM AND FAX TO US AT 412-682-2334

 1. Speaker:  ROCKY BLEIER  
 2. Organization:
 3. Date: ______________  4.  Time:  ______________
 5. Location
 6. Conference theme/function?
 7. Please provide a brief description /profile of your organization: 
 8. If this speaker could leave your group with two thoughts, what would they be? 
 9. What current challenges/problems does your industry face? 

ROCKY BLEIER
Page 2

Logistical Information

 10. Speaker’s Attire: (circle one)  

 Casual

 Business

 Black Tie
 11. Please specify the exact timetable of events the speaker needs to attend:
 12. Speaker’s Contact Prior to Meeting:

 Name: 

 Telephone:

  (office) _______________  (home) _______________
 13. Speaker’s Contact At Meeting Site:

 Name: 

 On-Site Phone:
 14. Event Site (city & venue):

 Telephone: 
 15. Accommodations (if different from event site): 

 Telephone: 

Confirmation #: 
 16. Ground Transportation:
  Please mail or fax this form to: 
Rocky Bleier, Inc.  c/o Gloria J. Ashcraft
     711 Filbert Street, Pittsburgh, PA  15232 • Fax: 412/682-2334