Workshop Booking and Contracting Form - Line Avers TODAY'S DATE1112345678910111229123456789101112131415161718192021222324252627282930312023202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920WORKSHOP PARTNER NAME(Required) First Last WORKSHOP PARTNER ORGANIZATION(Required) Workshop Partner Email(Required) Workshop Partner 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 WORKSHOP COURSE TITLE(Required) 3-Part Treatment Plan for OPT (Oral Placement Therapy) (Level One course requirement) OPT: Assessment and Program Plan Development (Level One course requirement) Other WORKSHOP INSTRUCTOR(Required) Line Avers = $3000 per day Line Avers = $335 per hour (for special events less than 1 day) WORKSHOP FORMAT(Required) Virtual/Streaming Live/In-Person VIRTUAL WORKSHOPS TalkTools will provide the virtual meeting platform Workshop Partner will provide the virtual meeting platform START DATE(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202320242025END DATE(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202320242025TOTAL NUMBER OF DAYS(Required) 1 2 3 4 SPECIAL EVENTS: Total Number of Hours(Required)Less than 1 day 1 2 3 4 5 Start Time(Required)Day 1 Hours : Minutes AM PM AM/PM End Time(Required)Day 1 Hours : Minutes AM PM AM/PM Start TimeDay 2 Hours : Minutes AM PM AM/PM End TimeDay 2 Hours : Minutes AM PM AM/PM Start TimeDay 3 Hours : Minutes AM PM AM/PM End TimeDay 3 Hours : Minutes AM PM AM/PM Start TimeDay 4 Hours : Minutes AM PM AM/PM End TimeDay 4 Hours : Minutes AM PM AM/PM ESTIMATED NUMBER OF PARTICIPANTS(Required)TalkTools expects the MAXIMUM number of participants for this workshop to be 60 (sixty) participants. For each participant exceeding this maximum number, the Workshop Partner will pay TalkTools® $40.00 per person for a 2-day workshop and $20.00 per person for a 1-day workshop. VIRTUAL OR IN-PERSON: Workshop Point of Contact (POC)(Required)VIRTUAL OR IN-PERSON: first name, last name VIRTUAL OR IN-PERSON: Workshop POC cell or WhatsApp or Messenger VIRTUAL OR IN-PERSON: Workshop POC email(Required) IN-PERSON: Workshop Venue Name and Address TOTAL HONORARIUM/SPEAKER COMPENSATION FOR THIS WORKSHOPDEPOSIT AMOUNTDEPOSIT IS EQUAL TO 25% OF THE TOTAL INSTRUCTOR COMPENSATION/HONORARIUM SPECIAL EVENTS: TOTAL HOURLY SPEAKER COMPENSATION FOR THIS WORKSHOPDUE WITHIN 30 DAYS OF INVOICE DATEPlease enter a number from 2600 to 4000.Will you need to purchase practicum (hands-on learning supplies) for this workshop(Required) Yes -- Workshop Partner will order practicum for each participant No -- Workshop Partner has the supplies and will assemble the practicum for each participant Practicum/Hands-On Learning Supplies List(Required)PLEASE REVIEW THE PRACTICUM LIST FOR THIS WORKSHOP - https://talktools.com/pages/live-workshop-practicum Workshop Partner has reviewed the practicum list Select the PRACTICUM SKU for this workshop if you are purchasing [SKU 3801] 3-Part Treatment Plan for OPT (Level One) [SKU 3803] OPT: Assessment and Program Plan Development (Level One) Select the PRACTICUM PRICE for this workshop if you are purchasing Three Part Treatment for OPT = $5 per participant OPT: Assessment and Program Plan Development= $10 per participant Estimated Practicum CostsIN-PERSON: Instructor Travel Terms(Required) Unless other terms have been agreed upon, Workshop Partner agrees that TalkTools will arrange airfare for Instructor based on estimates Workshop Partner has provided in this Agreement During the Instructor's stay for this Workshop, Workshop Partner agrees to pay and arrange for hotel accommodations, meals and transportation at reasonable rates TalkTools will bill Workshop Partner for any travel costs TalkTools has paid for, as part of the final invoice (due to TalkTools within 30 days after receipt of final invoice from TalkTools) IN-PERSON: Estimated Air TravelWorkshop Partner researches and provides air travel estimate. If virtual, leave blankEstimated Total Workshop Costshonorarium+speaker fee+estimated practicum if purchasing+estimated air travel if workshop is in-person
