Mr. or Ms.
Mr.
Ms.

First Name・・・Up to 32 characters


 MI・・・Up to 16 characters


Last Name・・・Up to 32 characters


 Suffix・・・(i.e. Jr, MD, PhD


E-Mail


Address・・・Up to 100 characters


City・・・Up to 50 characters


Zip・・・例：「163-6019」


 Nationality・・・Up to 50 characters


Home Phone・・・i.e. 03-3347-9740


 Mobile Phone・・・i.e. 090-1234-5678


How did you find out about AMA?
From AMA staff
From AMA faculty
From others
From AMA Website
ASTD
Other sources

 If other, please specify


 If AMA or other Personal Referral,
please specify the name.


 What is your area of expertise?
Leadership
Management
Communication
Marketing
Sales
HR
Finance & Accounting
Strategic Planning
Project Management
Process Management
Creativity
Other areas

 If other, please specify


 Which industry do you have business experience in?
Aerospace
Communications
Distribution
Energy
Financial Services
Food
Government
Insurance
Manufacturing
Manufacturing - Consumer Goods
Medical - Health care (non-drug companies)
Medical - Pharma (drug companies)
Non-profit / Membership/ Association
Publishing
Retail
Security
Transportation
Other

 If other, please specify.


Do you have experience in management?
Yes
No

Do you have experience in general management?
Yes
No

 Please indicate the company names where you previously led courses.


 Please indicate program areas in which previously led courses.


 Please indicate your Professional Certifications (i.e. MBTI, AFC, PMP)


 Please indicate your experience with Instructional Instruments.
DISC
FIRO-B
ISE
LSI
MBTI
Mindex
Neurolinguistic Communication Profile
Platinum Rule-Behavioral Profiles
Situational Leadership (Hersey)
Situational Leadership (Blanchard)
Survival Situation Simulation
Thomas-Kilmann conflict Mode
Other

 If other, please specify.


 What was the main audience level?
President/CEO
Senior Management
Middle Management
First-Line Manager
Administrative Support
Newly-hired employee
Tech/Professionals
Others

 If other, please specify.


 In which language could you lead a course?


 In which language could you communicate?
(in the level of reading, speaking, understanding, but not teaching )


 Do you have online facilitation experience?
Webcast
Online Course Instruction
Online Mentoring/ Coaching
None
Other

 If other, please specify.


 Which AMA seminars are you most interested in delivering for AMA?
Why do you think so?


 Do you have Instructional Design Experience?
Developed Assessment Tools
Case Studies
Programmed Instruction
Leader’s Guides
Participant Notebooks
Developing Content for E Delivery
Adult and Accelerated Learning Theory

 In which area(s) did you design the program?


Do you have experience in delivering programs that you did not design?
Yes
No

 How do you create a good relationship with the attendants during the course?


 As a trainer, what do you think your strength is compared to the others?


 What are your goals and expectations for working with AMA?


 What is your personal goal?


 Please provide any other message you feel appropriate to sell yourself.

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