Workshop Booking and Contracting Form -- Zaytoun Today's Date041234567891011121912345678910111213141516171819202122232425262728293031202420232024Workshop Partner Name(Required) First Last Workshop Partner Organization(Required) Workshop Partner Email(Required) Workshop Partner 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) OPT: 3-Part Treatment Plan (Level 1 course requirement) OPT: Assessment Plan Development (Level 1 course requirement) Feeding Foundations (Level 2 course elective Level 3 Advanced OPT Training (NOTE: addendum with additional terms will be sent after agreement is signed) Other Workshop Instructor(Required) Rehab Zaytoun (special rate) = $1875 per day Rehab Zaytoun (copresenting) = $1500 per day Rehab Zaytoun (regular rate) = $2500 Rehab Zaytoun (regular rate) = $3000 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 Timezone(Required) My timezone US timezone VIRTUAL OR IN-PERSON: Point of Contact (POC) during workshop(Required)VIRTUAL OR IN-PERSON: first name, last name Workshop Point of Contact (POC) email(Required) Workshop POC cell/WhatsApp/Messenger Workshop Venue and Addressname of workshop location, street, city Estimated Number of Participants(Required) Total Honorarium/Speaker Fee for this workshopDeposit AmountWill you need to Participant Practice Kits (practicum) 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 Participant Practice Kit (practicum) 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 purchasingWorkshop Partner agrees to the practicum price per participant for this workshop. Select the practicum for this workshop if you are purchasing [3801] 3-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 purchasingWorkshop Partner agrees to the practicum price per participant for this workshop. Select the practicum for this workshop if you are purchasing. If "other," enter the price ONLY, not the course title Three Part Treatment Plan for OPT = $5 per participant OPT: Assessment and Program Plan Development = $10 per participant Feeding Foundations: A Kaleidoscope Model = $5 per participant Other Estimated 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 accomodations, 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 Costshonorarium/speaker fee+estimated practicum if purchasing+estimated hotel and/or air travel as agreed upon if in-person
