{"id":4567,"date":"2014-02-12T00:25:59","date_gmt":"2014-02-12T06:25:59","guid":{"rendered":"https:\/\/drcarla.com\/home\/?page_id=4567"},"modified":"2014-02-21T15:32:41","modified_gmt":"2014-02-21T21:32:41","slug":"pre-event-form","status":"publish","type":"page","link":"https:\/\/drcarla.com\/home\/pre-event-form\/","title":{"rendered":"Pre-Event Questionnaire"},"content":{"rendered":"<div class=\"pbs-main-wrapper\"><p>Please take a few minutes to complete the Pre-Event Questionnaire before your phone meeting and at least 30 days prior to the scheduled event. Your answers will help Dr. Carla customize her presentation for your audience and help you achieve your goals.<\/p>\n<p>Thank you in advance!<\/p>\n\n\n<!-- Fast Secure Contact Form plugin 4.0.41 - begin - FastSecureContactForm.com -->\r\n<div style=\"clear:both;\"><\/div>\n\r\n<div id=\"FSContact4\" style=\"width:99%; max-width:555px;\">\r\n<form enctype=\"multipart\/form-data\" action=\"https:\/\/drcarla.com\/home\/wp-json\/wp\/v2\/pages\/4567#FSContact4\" id=\"fscf_form4\" method=\"post\">\r\n\n<div id=\"fscf_required4\">\n  <span style=\"text-align:left;\">*<\/span> <span style=\"text-align:left;\">indicates required field<\/span>\n<\/div>\n\n\n<div id=\"fscf_div_clear4_0\" style=\"clear:both;\">\n  <div id=\"fscf_div_field4_0\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\r\n    <div style=\"text-align:left; padding-top:5px;\">\n      <label style=\"text-align:left;\" for=\"fscf_name4\">Name:<span style=\"text-align:left;\">*<\/span><\/label>\n    <\/div>\r\n    <div style=\"text-align:left;\">\r\n      <input style=\"text-align:left; margin:0; width:99%; max-width:250px;\" type=\"text\" id=\"fscf_name4\" name=\"full_name\" value=\"\"  \/>\r\n    <\/div>\r\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear4_1\" style=\"clear:both;\">\n  <div id=\"fscf_div_field4_1\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div style=\"text-align:left; padding-top:5px;\">\n      <label style=\"text-align:left;\" for=\"fscf_email4\">Email:<span style=\"text-align:left;\">*<\/span><\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:250px;\" type=\"text\" id=\"fscf_email4\" name=\"email\" value=\"\"  \/>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear4_4\" style=\"clear:both;\">\n  <div id=\"fscf_div_field4_4\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label4_4\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field4_4\">Event title<span style=\"text-align:left;\">*<\/span><\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:250px;\" type=\"text\" id=\"fscf_field4_4\" name=\"event-title\" value=\"\"  \/>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear4_5\" style=\"clear:both;\">\n  <div id=\"fscf_div_field4_5\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label4_5\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field4_5\">What (if any) is the event theme or slogan used by your organization?<span style=\"text-align:left;\">*<\/span><\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:250px;\" type=\"text\" id=\"fscf_field4_5\" name=\"what-if-any-is-the-event-theme-or-slogan\" value=\"\"  \/>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear4_6\" style=\"clear:both;\">\n  <div id=\"fscf_div_field4_6\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label4_6\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field4_6\">Appearance #1: Speaker should report to (building and room including address)<span style=\"text-align:left;\">*<\/span><\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:250px;\" type=\"text\" id=\"fscf_field4_6\" name=\"appearance-1-speaker-should-report-to-bu\" value=\"\"  \/>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear4_7\" style=\"clear:both;\">\n  <div id=\"fscf_div_field4_7\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label4_7\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field4_7\">Appearance #2 (if applicable): Speaker should report to (building and room including address)<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:250px;\" type=\"text\" id=\"fscf_field4_7\" name=\"appearance-2-if-applicable-speaker-shoul\" value=\"\"  \/>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear4_8\" style=\"clear:both;\">\n  <div id=\"fscf_div_field4_8\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label4_8\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field4_8\">Appearance #3 (if applicable): Speaker should report to (building and room including address)<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:250px;\" type=\"text\" id=\"fscf_field4_8\" name=\"appearance-3-if-applicable-speaker-shoul\" value=\"\"  \/>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear4_22\" style=\"clear:both;\">\n  <div id=\"fscf_div_field4_22\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label4_22\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field4_22\">Will there be other speakers at the event? If so, please list here or upload a brochure (see below)<span style=\"text-align:left;\">*<\/span><\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:250px;\" type=\"text\" id=\"fscf_field4_22\" name=\"will-there-be-other-speakers-at-the-even\" value=\"\"  \/>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear4_9\" style=\"clear:both;\">\n  <div id=\"fscf_div_field4_9\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label4_9\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field4_9\">Have you planned any newspaper interviews or TV\/radio appearances? (if yes, provide details of each)<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <textarea style=\"text-align:left; margin:0; width:99%; max-width:250px; height:120px;\" id=\"fscf_field4_9\" name=\"have-you-planned-any-tv-or-radio-appeara\" cols=\"30\" rows=\"10\" ><\/textarea>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear4_10\" style=\"clear:both;\">\n  <div id=\"fscf_div_field4_10\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label4_10\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field4_10\">Dr. Carla&#039;s hotel accommodations (if provided) will be at: (name, address and confirmation number)<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:250px;\" type=\"text\" id=\"fscf_field4_10\" name=\"lodging-for-dr-carla-if-provided-will-be\" value=\"\"  \/>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear4_12\" style=\"clear:both;\">\n  <div id=\"fscf_div_field4_12\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label4_12\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field4_12\">What is the demographic makeup of the audience for each presentation? (please describe the average age, socioeconomic background, racial\/cultural mix, gender, education, profession, etc.)<span style=\"text-align:left;\">*<\/span><\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <textarea style=\"text-align:left; margin:0; width:99%; max-width:250px; height:120px;\" id=\"fscf_field4_12\" name=\"what-is-the-demographic-makeup-of-the-au\" cols=\"30\" rows=\"10\" ><\/textarea>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear4_13\" style=\"clear:both;\">\n  <div id=\"fscf_div_field4_13\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label4_13\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field4_13\">Should the message be targeted to one group in preference to another? If yes, which one?<span style=\"text-align:left;\">*<\/span><\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <textarea style=\"text-align:left; margin:0; width:99%; max-width:250px; height:120px;\" id=\"fscf_field4_13\" name=\"should-the-message-be-targeted-to-one-gr\" cols=\"30\" rows=\"10\" ><\/textarea>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear4_14\" style=\"clear:both;\">\n  <div id=\"fscf_div_field4_14\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label4_14\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field4_14\">What challenges or frustrations does your audience experience in their lives\/work? (related to the presentation topic)<span style=\"text-align:left;\">*<\/span><\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <textarea style=\"text-align:left; margin:0; width:99%; max-width:250px; height:120px;\" id=\"fscf_field4_14\" name=\"what-challenges-or-frustrations-does-you\" cols=\"30\" rows=\"10\" ><\/textarea>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear4_15\" style=\"clear:both;\">\n  <div id=\"fscf_div_field4_15\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label4_15\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field4_15\">What specific local issues is your audience facing related to the presentation topic? (i.e., youth trends, parent\/educator concerns, etc.)<span style=\"text-align:left;\">*<\/span><\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <textarea style=\"text-align:left; margin:0; width:99%; max-width:250px; height:120px;\" id=\"fscf_field4_15\" name=\"what-specific-local-issues-is-your-audie\" cols=\"30\" rows=\"10\" ><\/textarea>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear4_16\" style=\"clear:both;\">\n  <div id=\"fscf_div_field4_16\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label4_16\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field4_16\">What are the sensitive issues? Are there controversial issues that should be avoided?<span style=\"text-align:left;\">*<\/span><\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <textarea style=\"text-align:left; margin:0; width:99%; max-width:250px; height:120px;\" id=\"fscf_field4_16\" name=\"what-are-the-sensitive-issues-are-there\" cols=\"30\" rows=\"10\" ><\/textarea>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear4_17\" style=\"clear:both;\">\n  <div id=\"fscf_div_field4_17\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label4_17\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field4_17\">What three points of information do you want Dr. Carla to address during her presentation(s)?<span style=\"text-align:left;\">*<\/span><\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <textarea style=\"text-align:left; margin:0; width:99%; max-width:250px; height:120px;\" id=\"fscf_field4_17\" name=\"what-three-points-of-information-do-you\" cols=\"30\" rows=\"10\" ><\/textarea>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear4_18\" style=\"clear:both;\">\n  <div id=\"fscf_div_field4_18\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label4_18\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field4_18\">How do you want people to feel when they leave the presentation(s)?<span style=\"text-align:left;\">*<\/span><\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:250px;\" type=\"text\" id=\"fscf_field4_18\" name=\"how-do-you-want-people-to-feel-when-they\" value=\"\"  \/>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear4_19\" style=\"clear:both;\">\n  <div id=\"fscf_div_field4_19\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label4_19\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field4_19\">What other information might be helpful for Dr. Carla to know?<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <textarea style=\"text-align:left; margin:0; width:99%; max-width:250px; height:120px;\" id=\"fscf_field4_19\" name=\"what-other-information-might-be-helpful\" cols=\"30\" rows=\"10\" ><\/textarea>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear4_2\" style=\"clear:both;\">\n  <div id=\"fscf_div_field4_2\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div style=\"text-align:left; padding-top:5px;\">\n      <label style=\"text-align:left;\" for=\"fscf_field4_2\">Subject:<span style=\"text-align:left;\">*<\/span><\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:250px;\" type=\"text\" id=\"fscf_field4_2\" name=\"subject\" value=\"\"  \/>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear4_20\" style=\"clear:both;\">\n  <div id=\"fscf_div_field4_20\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label4_20\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field4_20\">Please upload the event brochure or marketing flyer\/materials (up to 2 mb permitted)<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:250px;\" type=\"file\" id=\"fscf_field4_20\" name=\"please-upload-the-event-brochure-or-mark\"  size=\"20\" \/><br \/>\n      <span id=\"fscf_hint_file_types4_20\" style=\"font-size:x-small; font-weight:normal;\">Acceptable file types: doc,docx,pdf,txt,gif,jpg,jpeg,png.<br \/>Maximum file size: 2mb.<\/span>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear4_21\" style=\"clear:both;\">\n  <div id=\"fscf_div_field4_21\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label4_21\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field4_21\">Please upload the agenda (up to 2 mb permitted)<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:250px;\" type=\"file\" id=\"fscf_field4_21\" name=\"please-upload-the-agenda-up-to-2-mb-perm\"  size=\"20\" \/>    <\/div>\n  <\/div>\n<\/div>\r\n<div style=\"clear:both;\"><\/div>\n\n<div style=\"text-align:left; padding-top:5px;\">\n<\/div>\n<div id=\"fscf_captcha_image_div4\" style=\"width:250px; height:65px; padding-top:2px;\">\n      <img decoding=\"async\" id=\"fscf_captcha_image4\" style=\"border-style:none; margin:0; padding:0px; padding-right:5px; float:left;\" src=\"https:\/\/drcarla.com\/home\/wp-content\/plugins\/si-contact-form\/captcha\/securimage_show.php?prefix=13G7LsZLcgwgAtlx\" width=\"175\" height=\"60\" alt=\"CAPTCHA Image\" title=\"CAPTCHA Image\" \/>\n      <input id=\"fscf_captcha_prefix4\" type=\"hidden\" name=\"fscf_captcha_prefix4\" value=\"13G7LsZLcgwgAtlx\" \/>\n     <div id=\"fscf_captcha_refresh4\">\n        <a href=\"#\" rel=\"nofollow\" title=\"Refresh Image\" onclick=\"fscf_captcha_refresh('4','\/home\/wp-content\/plugins\/si-contact-form\/captcha','https:\/\/drcarla.com\/home\/wp-content\/plugins\/si-contact-form\/captcha\/securimage_show.php?prefix='); return false;\">\n        <img decoding=\"async\" src=\"https:\/\/drcarla.com\/home\/wp-content\/plugins\/si-contact-form\/captcha\/images\/refresh.png\" width=\"22\" height=\"20\" alt=\"Refresh Image\" style=\"border-style:none; margin:0; padding:0px; vertical-align:bottom;\" onclick=\"this.blur();\" \/><\/a>\r\n     <\/div>\r\n<\/div>\r\n\r\n<div id=\"fscf_captcha_field4\" style=\"text-align:left; padding-top:5px;\">\r\n     <label style=\"text-align:left;\" for=\"fscf_captcha_code4\">CAPTCHA Code:<span style=\"text-align:left;\">*<\/span><\/label>\r\n<\/div>\r\n<div style=\"text-align:left;\">\n     <input style=\"text-align:left; margin:0; width:50px;\" type=\"text\" value=\"\" id=\"fscf_captcha_code4\" name=\"captcha_code\"  \/>\n<\/div>\n\n<div id=\"fscf_submit_div4\" style=\"text-align:left; clear:both; padding-top:15px;\">\r\n\t\t<input type=\"submit\" id=\"fscf_submit4\" style=\"cursor:pointer; margin:0;\" value=\"Submit\"  onclick=\"this.disabled=true; this.value='Submitting...'; this.form.submit();\" \/> \n<\/div>\n\n<input type=\"hidden\" name=\"fscf_submitted\" value=\"0\" \/>\n<input type=\"hidden\" name=\"fs_postonce_4\" value=\"94e08dcecc8ae340c69193523742f382,1777130798\" \/>\n<input type=\"hidden\" name=\"si_contact_action\" value=\"send\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"4\" \/>\n<input type=\"hidden\" name=\"mailto_id\" value=\"1\" \/>\n\n<\/form>\n<\/div>\r\n<div style=\"clear:both;\"><\/div>\nThank you for completing the pre-event questionnaire. We will be in touch shortly to schedule your pre-event phone call.\n<!-- Fast Secure Contact Form plugin 4.0.41 - end - FastSecureContactForm.com -->\n\n<\/div>","protected":false},"excerpt":{"rendered":"<p>Please take a few minutes to complete the Pre-Event Questionnaire before your phone meeting and at least 30 days prior to the scheduled event. Your answers will help Dr. Carla customize her presentation for your audience and help you achieve your goals. Thank you in advance!<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"open","ping_status":"open","template":"","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":"","_links_to":"","_links_to_target":""},"class_list":["post-4567","page","type-page","status-publish","hentry","entry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Pre-Event Questionnaire - Teen Girl Speaker \u2013 Life Coach for Teen Girls - Female Youth Motivational Speaker for Teen Girls \u2013 Atlanta Teen Girl Life Coach - Teen Girl Expert | Dr. Carla Stokes<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/drcarla.com\/home\/pre-event-form\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Pre-Event Questionnaire - Teen Girl Speaker \u2013 Life Coach for Teen Girls - Female Youth Motivational Speaker for Teen Girls \u2013 Atlanta Teen Girl Life Coach - Teen Girl Expert | Dr. Carla Stokes\" \/>\n<meta property=\"og:description\" content=\"Please take a few minutes to complete the Pre-Event Questionnaire before your phone meeting and at least 30 days prior to the scheduled event. 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