Workshop Booking and Contracting Form -- Anderson Smith Today's Date09123456789101112071234567891011121314151617181920212223242526272829303120242025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Workshop Partner Full Name First Last Workshop Partner Organizaton(Required) Workshop Partner email(Required) Address 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(Required) Three-Part Treatment Plan for OPT OPT: Assessment and Program Plan Development Feeding Foundations: A Kaleidoscope Model Other Workshop Instructor(Required) Vanessa Anderson-Smith = $2,500 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)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202320242025End Date(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202320242025Total 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 Workshop Venue and Addressname of workshop location, street, city Workshop Point of Contact (POC)(Required)VIRTUAL OR IN-PERSON: first name, last name Workshop Partner agrees to be responsible for any catering during the workshop Workshop Partner agrees 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. Total Honorarium/Speaker Fee for this workshopDeposit AmountDeposit is equal to 25% of the total speaker fee/honorarium for Instructor 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 Workshop agrees to provide practicum for each participant Select the PRACTICUM SKU for this workshop if you are purchasing(Required) [3801] Three Part Treatment Plan for OPT (Level 1) [3803} OPT: Assessment and Program Plan Development (Level 2) [3831] Feeding Foundations: A Kaleidoscope Model Other this is a placeholder for the purposes of estimating workshop costs) Select the PRACTICUM PRICE for this workshop if you are purchasing(Required)Workshop Partner agrees to the practicum price per participant for this workshop. Select the practicum for this workshop if you are purchasing Three Part Treatment Plan for OPT (Level 1) = $5 per participant OPT: Assessment and Program Plan Development (Level 2) = $10 per participant Feeding Foundations: A Kaleidoscope Model = $5 per participant Other = $5 per participant (this is a placeholder for the purposes of estimating workshop costs) Estimated Practicum CostsInstructor Travel Terms(Required) 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 these costs, as part of the final invoice (due to TalkTools within 10 days of the workshop dates) Estimated AirfareWorkshop Partner researches and provides air travel estimateEstimated Total Workshop Costshonorarium/speaker fee+estimated practicum if purchasing+estimated air travel if workshop is in-person
