Domestic (US) Workshop Partner-Private Group [SELF-STUDY] Gravity Form to e-signature-Domestic (US) Partner-Private Group [SELF-STUDY] Today's Date MM slash DD slash YYYY Workshop Partner Name(Required) First Last Workshop Partner Organizaton(Required)Workshop Partner Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Workshop Partner email(Required) Point of Contact POC (Point of Contact) during the trainingPoint of Contact (POC) cellConfirm the format for this training(Required) self-study (recorded on-demand presentation) limited time recorded presentation (exclusive to your group) Course Title(Required)Course Description(Required) I have reviewed the course description for this course Start Date(Required) MM slash DD slash YYYY End Date(Required) MM slash DD slash YYYY Registration Fee per hour(Required) $300 Number of hours for this course(Required) 1 2 3 4 5 6 7 8 9 10 11 12 Total Registration FeeEstimated Number of ParticipantsWorkshop Partner agrees to provide updated registration list(s)(Required) Yes Participant Listif you have the participant list available, please upload -- if you do not have participant list at this time, we will follow up after the contract is signedAccepted file types: xls, xlsx, csv, Max. file size: 256 MB.Student Practice Tools Kits (Practicum)(Required) Workshop Partner will purchase practicum kits for each participants if required This course does not require practicum kits Practicum Cost per participant $5 per person (Three Part Treatment Plan for OPT, Superpowers of the Sensory System, Kaleidoscope Model for Feeding, Feeding Therapy, Eating and Swallowing $10 per person (OPT: Assessment and Program Plan Development, Functional Assessment and Remediation of TOTs) $25 per person (Motor Speech Series) Total Practicum CostsIs TalkTools managing CEUs for this event on behalf of the Workshop Partner?(Required) Yes No I agree to the CEU filing fee $5 (per participant) Estimated CEU Filing FeeEstimated Total Training Costs
