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Please identify the seminar you are attending today:
 
Seminar Topic 1
 
Seminar Topic 2
 
Seminar Topic 3
 
Seminar Topic 4
 
Seminar Topic 5
 
Seminar Topic 6
 
Seminar Topic 7
 
Seminar Topic 8
 
Other
   
 
Name:
   
   
 
Gender:
 
Male
 
Female
   
 
Company:
   
   
 
Work Telephone:
   
   
 
Mailing Address:
   
   
 
City:
   
   
 
State:
   
   
 
Zip Code:
   
   
 
Home Telephone:
   
   
 
E-Mail:
   
   
 
Please select your age group:
 
20 & under
 
21-25
 
26-30
 
31-35
 
36-40
 
41-45
 
46-50
 
51-55
 
56 & over
   
 
Occupation:
Title (If Applicable):
 
Computer Tech.
 
Education
 
Engineering
 
Professional
 
Production Worker
 
Salesperson
 
Finance
 
Human Resources/Training
 
Legal
 
First-Line Supervisor
 
Customer Service Rep.
 
Executive
 
Manufacturing
 
Marketing/Advertising
 
Medical
 
Middle Management
 
Senior Manager
 
Administrative Employee
 
Sales
 
Services
 
Other
   
 
Do you have people that report to you? If yes, how many?
   
   
 
Highest Level of Education Completed:
 
High School or less
 
Some College
 
College Degree
 
Graduate/Post Graduate
   
 
Current Annual Household Income (Optional):
 
up to 20,000
 
20,001 - 40,000
 
40,001 - 60,000
 
60,001 - 80,000
 
80,001 - 100,000
 
100,001 - 150,000
 
150,001 - 200,000
 
200,001 - 250,000
 
250,000 or over
   
 
Why did you select today's seminar date and location? (Select the most important one)
 
Date
 
Seminar City
 
Hotel Location
 
Other
   
 
How far did you travel to today's seminar?
 
0-25 miles
 
26-50 miles
 
over 50 miles
   
 
How did you pay for today's seminar?
 
Personal funds
 
Company paid
 
Company reimbursed
 
Personal gift
 
Other
   
 
What other seminars have you attended? (Select all that apply):
 
Seminar Topic 1
 
Seminar Topic 2
 
Seminar Topic 3
 
Seminar Topic 4
 
Seminar Topic 5
 
Seminar Topic 6
 
Other

   
 
What other seminars are you interested in attending? (Select all that apply):

 
Seminar Topic 1
 
Seminar Topic 2
 
Seminar Topic 3
 
Seminar Topic 4
 
Seminar Topic 5
 
Seminar Topic 6
 
Seminar Topic 7
 
Seminar Topic 8

   
 
Where did you initially hear about this seminar? (Select one):
 
Direct mail piece
 
Recommended by co-worker
 
Received catalog
 
My boss
 
Visited store
 
Contacted by sales associate
 
Recommended by friend/family member
 
Other
   
 
What influenced you to attend today's seminar? (Select one):
 
Direct mail piece
 
Recommended by co-worker
 
Received catalog
 
My boss
 
Visited store
 
Contacted by sales associate
 
Recommended by friend/family member
 
Other
   
 
Did you make the decision to attend today's seminar?
 
Yes
 
No, my organization sent me.


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