The following is an excerpt from Market Yourself as a Speaker by Susan Levin

Sample Evaluation Form

Please help me to increase the value of my presentation to you by evaluating my program.

What ideas did you find most helpful?

What would you like to see included in the program?

Your thoughts and feedback on the program?

May I quote you? (good for your press kits)

Yes! Please send more information.

I'm interested in:
_____ a private consultation _____ support group _____ upcoming seminars
_____ books, tapes, videos _____ customized program for my group/business
Name
Address City St Zip
Tel # FAX # e-mail address

Do you know anyone who could benefit from my services?
Please provide me with their name and address and I will contact them.
Name
Address City St Zip
Tel # FAX # e-mail address

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