Instructor Contracting Form Today's Date MM slash DD slash YYYY Instructor Name(Required) First Last Instructor Credentials(Required) Instructor Email(Required) Speaker cell phone (or Facebook Messenger or WhatsApp)(Required) Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Type of Event(Required)a "standard training event" is a workshop (12 hours of instructional time); a "shorter/special event" is a webinar, conference session or special event requested by our Partner Standard Training Event Special event/Short Course/Conference Session Format(Required) Virtual In-Person TalkTools Hosted or Partner Hosted TalkTools Hosted Partner Hosted If Partner Hosted, Partner LocationCity, (State if in the US), Country If Partner Hosted, Name of Workshop Partner Are there additional compensation and/or reimbursement terms for this event?(Required)ex., travel reimbursement Yes No Standard WorkshopsCourse Title 3-Part Treatment Plan for OPT (Oral Placement Therapy) OPT: Assessment and Program Plan Development Feeding Foundations Other If "other," enter course title below Start DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20232024End DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20232024Total Number of Days 1 day 2 days 3 days Standard Daily Speaker Fee/Honorariumthe workshop can be scheduled over 2 days or 3 days but the instructional time will always be 12 hours $1500 (for two day workshop) $1000 (for three day workshop) Total Standard Training Fee/Honorariumauto-calculationSpecial/Shorter Training Eventthis can be a webinar, a conference session or a training event requested by one of our PartnersIs this part of a TalkTools-Hosted Conference Yes No -- this is a stand-alone webinar Name of TalkTools-Hosted Conference Conference Start DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20232024Conference End DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20232024Special Event/Short Course/Conference Session Title Special Event/Short Course/Conference Session DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20232024Special Event/Short Course Conference Session Start Time Hours : Minutes AM PM AM/PM Special Event/Short Course/Conference Session End Time Hours : Minutes AM PM AM/PM Compensation RateWhat is your rate for this special event/short course/conference session? Standard Hourly Rate (based on your daily rate) Special Rate Total Number of Hoursif the shorter course is more than 5 hours, then we will schedule it as a one-day workshop 1 hour 2 hours 3 hours 4 hours 5 hours Hourly Rate for this eventbased on daily compensation rate (6 hours)Speaker Compensation based on hourly rateauto-calculationSPECIAL RATE: If you have negotiated a special rate for this event, enter belowas agreed upon by the Speaker and TalkTools via email.Additional Reimbursement and/or CompensationAdditional Compensation and/or Reimbursement Termswhat additional expenses is TalkTools covering as agreed upon by the Speaker and TalkTools via email. Additional Compensation and/or Reimbursement Amountas agreed upon by the Speaker and TalkTools via email.Total Compensationauto-calculationIf there are changes to you bio, upload hereMax. file size: 128 MB.If you have a new headshot, upload hereMax. file size: 128 MB.If this is a new course, upload the course descriptionMax. file size: 128 MB.
