Workshop Booking and Contracting Form-Domestic (US) Partner (Private Group)

Gravity Form to e-signature-Domestic (US) Partner-Private Group

Today's Date

Workshop Partner Info

Workshop Partner Name(Required)

First Last

Workshop Partner Organization(Required)

Workshop Partner Email(Required)

Workshop Partner other communications (cell, WhatsApp, Messenger)

Workshop Partner Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Have you attended or hosted a TalkTools in-person workshop before?(Required)

Yes

Workshop Details

What format is this workshop(Required)

Virtual/Streaming (TalkTools will provide the virtual meeting platform)

Virtual/Streaming (Workshop Partner will provide the virtual meeting platform)

Onsite/In-Person

IN-PERSON: To avoid cancellation, TalkTools reserved the right to offer this workshop in a virtual streaming format if there are travel issues, inclement weather or other issues that preclude the Instructor from teaching onsite/in person(Required)

Workshop Partner agrees

IN-PERSON OR VIRTUAL: Will you be attending each day of this workshop(Required)

Yes

No -- my colleague will be attending (see below)

Workshop Course(Required)

Workshop Instructor(Required)

Colette Ellis = $2750 per day (Three-Part Treatment Plan for OPT | OPT: Assessment and Program Plan Development | Eating Drinking Swallowing DAY TWO)

Robyn Merkel Walsh = $3250 per day

Robyn Merkel Walsh = $4250 per day (TOTs Course ONLY)

Lori Overland = $4000 per day

Monica Purdy = $3000 per day

Renee Roy Hill = $3500 per day

Risca Solomon = $2500 per day (VIRTUAL)

Rehab Zaytoun = $2500 per day (VIRTUAL)

Workshop Partner has read the course description and timed agenda for this workshop(Required)

Course Descriptions can be found on: https://talktools.com/pages/opt-course-descriptions (timed agendas link are included on each course description page)

I have the course description and timed agenda for this workshop

Start Date(Required)

End Date(Required)

Start Time Day 1

End Time Day 1

Start Time Day 2

End Time Day 2

Total Number of Days(Required)

Estimated Number of Participants(Required)

Private Group Base Fee (Speaker Compensation)

this covers the Speaker Fee/Honorarium)

IN-PERSON OR VIRTUAL: Workshop Partner agrees to provide a registration list to TalkTools.(Required)

Registration list allows TalkTools to enroll participants in TalkTools online training portal, file CEUs on behalf of learners (if TalkTools is filing CEUs) and ship any workshop materials as needed. Digital handouts, any quizzes, digital exit survey (for CEUs) and certificate of completion is available ONLY IN THE TALKTOOLS TRAINING PORTAL.

Participant list must include First Name, Last Name, Street Address, City, ST, ZIP and email address. and email address

IN-PERSON OR VIRTUAL: Point of Contact POC First Name Last Name during the workshop(Required)

IN-PERSON OR VIRTUAL: Point of Contact (POC) cell(Required)

IN-PERSON OR VIRTUAL: Point of Contact (POC) email(Required)

IN-PERSON: Venue/Location Address

IN-PERSON: Venue Meeting Room Requirements(Required)

Workshop Partner will ensure meeting room requirements are met

IN PERSON: Feeding Therapy: A Sensory-Motor Approach -- Instructor Seating

A high bar stool is requested

Yes -- we have a stool available

No -- we don't have a stool available

IN PERSON: Feeding Therapy: A Sensory Motor Approach -- Live Evaluations

Do you have 2 candidates confirmed for the instructor to evaluate IN PERSON each workshop day?

Yes

Not at the time of signing this contract, but we will have this information before the workshop

IN PERSON: Feeding Therapy: A Sensory Motor Approach -- If you have 2 live evaluations confirmed, provide the names, ages and diagnosis

If you do not have evaluations scheduled at the time of signing this agreement, provide a date when you will have evaluations scheduled

IN-PERSON: OPT: Assessment and Program Plan Development -- Live Evaluations

Do you have 2 candidates confirmed for the instructor to evaluate IN PERSON each workshop day?

Yes

IN PERSON: OPT: Assessment and Program Plan Development -- If you have 2 live evaluations confirmed, provide the names, ages and diagnosis

If you do not have evaluations scheduled at the time of signing this agreement, provide a date when you will have evaluations scheduled

IN PERSON: Ground Transportation will be provided(Required)

this includes transportation to/from airport/hotel, hotel/workshop venue

Yes

We are unable to coordinate ground transportation for the Instructor

IN PERSON: Ground Transportation POC First Name Last Name

if this is the same person, enter "same as Workshop POC" below

IN PERSON: Ground Transportaton POC communication

cell, WhatsApp, Messenger

IN PERSON: Ground Transportaton POC email

IN PERSON OR VIRTUAL Practice Kits (Practicum)(Required)

PLEASE REVIEW THE PRACTICUM LIST FOR THIS WORKSHOP - https://talktools.com/pages/live-workshop-practicum.

I have reviewed the practicum list

Select Practicum for this Workshop

[3801] Three Part Treatment Plan for OPT

[3803] OPT Assessment and Program Plan

[3802] Feeding Therapy: A Sensory Motor Approach

[3822] Superpowers of the Sensory System

[3829] MYOTools 101

[3830] MYOTools 102

[3831] Kaleidoscope Model for Feeding

[3817] Motor Speech Part 1 + [3808] Motor Speech Part 2

[3804] {3806] Functional Assessment and Remediation of TOTs (2 days)

Select Pricing for Practicum Kits

Three Part Treatment Plan for OPT = $5 per participant

OPT Assessment and Program Plan = $15 per participants

Feeding Therapy: A Sensory Motor Approach = $5 per participant

Superpowers of the Sensory System = $5 per participant

MYOTools (Part One) = $5 per participant

MYOTools (Part Two) = $5

Kaleidoscope Model for Feeding = $5 per participant

Motor Speech Disorders two days = $30 per participant

Functional Assessment and Remediation of TOTs = $10 per participants

Estimated Practicum Costs

VIRTUAL: TalkTools will ship individual Practicum/Hands-On Supply Kits

Workshop Partner agrees to provide an accurate and up to date registration list so TalkTools can ship Practicum/Hands-on Kits to each participant. Registration list must include: First Name, Last Name, Street Address, City, ST, ZIP, email address

Practice Kits (Practicum)

Virtual: TalkTools will ship individual Practice Kits to each participant. Workshop Partner agrees to provide up-to-date registration list with name, email address, cell phone and mailing address

In-Person: TalkTools will bulk ship all practice kits to address provided by Workshop Partner. Workshop Partner will provide mailing address within 14 days of workshop dates

IN-PERSON: TalkTools will ship ALL workshop materials to address provided below

Additional Workshop Terms

IN-PERSON OR VIRTUAL: Workshop Partner Shipping Responsibilities(Required)

Workshop Partner agrees to pay a portion of shipping costs (not to exceed $100) for both IN-PERSON and VIRTUAL workshop formats

Is TalkTools managing CEUs for this event on behalf of the Workshop Partner?(Required)

Yes

IF TALKTOOLS IS FILING CEUs FOR PARTICIPANTS: Workshop Partner agrees to the CEU Filing Per-Person Fee

click on button below

$10 (per participant)

Estimated CEU Filing Fee for participants as listed on the registration list provided by Workshop Partner

auto-calculation

Workshop Private Group ESTIMATED TOTAL Fees

auto-calculation: Private Workshop Base Fee (Speaker Fee/Honorarium) + practicum kits + CEU Filing Fee (if TalkTools is filing for Workshop Partner). Shipping costs (not to exceed $100) will be calculated after the workshop. Actual Costs will be invoiced within 10 days after the workshop date