Workshop Booking and Contracting Form - Carmenza Herrera Today's Date0312345678910111229123456789101112131415161718192021222324252627282930312023202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Workshop Partner Full Name First Last Workshop Partner Organization(Required) Workshop Partner email(Required) Workshop Partner Organization Street Address(Required) Workshop Partner Organization City(Required) Workshop Partner Organization Country(Required) Workshop Course(Required) OPT: Three Part Treatment Plan (Level 1 course requirement) OPT: Assessment Plan (Level 1 course requirement) Other Workshop Instructor(Required) Carmenza Herrera = $2500 per day 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) Live/In-Person Start Date(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20222023End Date(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20222023Total Number of Days(Required)Start Time(Required)each day Hours : Minutes AM PM AM/PM End Time(Required)each day Hours : Minutes AM PM AM/PM Are these times in YOUR timezone?(Required) The times are in my time zone The times are US Eastern (UTC-4) Workshop Venuename of workshop location, street, city Workshop Point of Contact (POC) during workshop(Required)VIRTUAL OR IN-PERSON: first name, last name Workshop POC email(Required) Estimated Number of Participants(Required)Total Honorarium/Speaker Fee for this workshopDeposit AmountDeposit is equal to 25% of the total speaker fee/honorarium for InstructorWill 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 Workshop Partner agrees to provide practicum for each participant Select the PRACTICUM SKU for this workshop if you are purchasing [3801] Three Part Treatment Plan for OPT [3803] OPT: Assessment and Program Plan Development Other Select the PRACTICUM PRICE this workshop if you are purchasing $8 (Three Part Treatment Plan for OPT) $25 (OPT: Assessment and Program Plan Development) Other Practicum price per participantEstimated Practicum Costsauto-calculatedInstructor Travel Terms(Required) Workshop Partner agrees that TalkTools will arrange airfare for Instructor based on estimates Workshop Partner has provided in this Agreement TalkTools will invoice Workshop Partner for any travel costs TalkTools pay for prior to the workshop, as part of the final invoice (due to TalkTools within 10 days of the workshop dates) During the Instructor's stay for this Workshop, Workshop Partner agrees to pay and arrange for hotel accommodations, meals and transportation at reasonable rates Estimated Air Travel(Required)Estimated Total Workshop Costsauto-calculated (honorarium/speaker fee+estimated practicum if purchasing+estimated air travel if workshop is in-person)
