Workshop Agreement International Partner 3 Day Today's Date Month Day Year Workshop Partner Name(Required) First Last Workshop Partner Organization(Required) Workshop Partner Email(Required) Workshop Partner Address(Required) Street Address Address Line 2 City 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(Required) OPT: Three Part Treatment Plan (Level 1) OPT: Assessment Plan Development (Level 1) Superpowers of the Sensory System Level 3 (Addendum for this course will be sent after the Agreement is signed) Level 4 (Addendum for this course will be sent after the Agreement is signed) Feeding Foundations Other Workshop Instructor(Required) Monica Purdy = $3150 per day for two day workshop Monica Purdy = $2100 per day for three day workshop (same number of hours as two day) What format is this workshop(Required) Virtual/Streaming Live/In-Person If this workshop is virtual, who is providing the virtual streaming platform Workshop Partner will provide the virtual meeting platform (ex., Zoom) TalkTools will provide the virtual meeting platform Start Date(Required)MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2024202520262027End Date(Required)MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2024202520262027Total 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) Yes, these times are my timezone No, these times are US Eastern timezone IN-PERSON: Workshop Venuename of workshop location, street, city VIRTUAL OR IN-PERSON: Point of Contact (POC) during workshop(Required)first name, last name Estimated Number of Participants(Required)Honorarium/Speaker Fee for this workshopDeposit AmountDeposit is equal to 25% of the total speaker fee/honorarium for InstructorParticipant Practice Kits (practicum) list(Required)PLEASE REVIEW THE PRACTICUM LIST FOR THIS WORKSHOP Workshop Partner has reviewed the practicum list Workshop Partner agrees to provide practicum for each participant Will you need to purchase Participant Practice Kits (practicum) for this workshop(Required) Yes -- Workshop Partner will order practicum for each participant from TalkTools No -- Workshop Partner will arrange workshop tools and products through TalkTools Distributor Select the Participant Practice Kits (practicum) SKU for this workshop [3801] Three Part Treatment Plan for OPT [3803] OPT: Assessment and Program Plan Development [3816] Level 3 [3818] Level 4 [3824] Superpowers of the Sensory System [3831] Kaleidoscope Model for Feeding Select the Participant Practice Kits (practicum) PRICE for this workshop Three Part Treatment Plan for OPT $5 per participant OPT: Assessment and Program Plan Development $10 per participant Level 3 Level 4 Superpowers of the Sensory System $5 per participant Kaleidoscope Model for Feeding $5 per participant Estimated Practice Kit (practicum) CostsInstructor Travel Terms Unless other terms are agreed upon, Workshop Partner agrees that TalkTools will arrange cost-effective airfare for Instructor During the Instructor's stay for this Workshop, Workshop Partner agrees to pay and arrange for accommodations, meals and transportation TalkTools will invoice Workshop Partner for any travel costs incurred, as part of the final invoice (due to TalkTools within 30 days of the invoice date) Estimated Total Workshop Costs
