Workshop Partner Booking and Contracting Form-International (Hill)

Workshop Booking and Contracting Form - Renee Roy Hill

Today's Date

Workshop 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)

3-Part Treatment Plan for OPT (Level 1 requirement)

OPT: Assessment and Program Plan Development (Level 1 requirement)

Is it CAS (Childhood Apraxia of Speech)? Differential Diagnosis and Treatment (Level 2 elective)

Eating and Swallowing: A Global Approach to Feeding (Level 2 elective)

Taking Your Client with Autism from Non-Vocal to Verbal (Level 2 elective)

Level 3 (Note: there is an addendum for this course and will be sent after this agreement is signed)

Level 4 (Note: there is an addendum for this course and will be sent after this agreement is signed)

Workshop Instructor(Required)

NOTE: Eating Drinking Swallowing: A Global Approach is co-presented by 2 Instructors, Renee Roy Hill and Colette Ellis, so TWO CONTRACTS are needed (one for each Instructor). When entering the number of days, enter "1."

Renee Roy Hill = $3500 per day

Renee Roy Hill = $3500 Eating Drinking Swallowing Day One ONLY

What format is this workshop(Required)

Virtual/Streaming

Live/In-Person

If this workshop is virtual, will TalkTools or the Workshop provide the virtual meeting platform (i.e., Zoom)

TalkTools will provide the virtual meeting platform

Workshop Partner will provide the virtual meeting platform

Start Date(Required)

End Date(Required)

Total Number of Days(Required)

Start Time(Required)

each day

AM/PM

End Time(Required)

each day

AM/PM

Workshop Venue Name and Address

Workshop Venue/Location POC(Required)

VIRTUAL OR IN-PERSON: first name, last name

Workshop POC email(Required)

Estimated Number of Participants(Required)

Total Honorarium/Speaker Fee for this workshop

Deposit Amount

Deposit 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)

No -- Workshop Partner has the supplies and will assemble the practicum

Yes -- Workshop Partner needs to order practicum kits

Practicum/Hands-On Learning Supplies(Required)

PLEASE REVIEW THE PRACTICUM LIST FOR THIS WORKSHOP - https://talktools.com/pages/live-workshop-practicum

I have reviewed the practicum list

I agree to provide practicum for each workshop participant

Select PRACTICUM SKU for this Workshop

[3801] Three Part Treatment for OPT (Oral Placement Therapy

[3803] OPT: Assessment and Program Plan Development

[3808] Is it CAS? DIfferential Diagnosis and Treatment

[3815] Taking Your Client with Autism from Non-Vocal to Verbal

[3816] Level 3 (included in the workshop costs)

[3816] Level 4 (included in the workshop costs)

Other (this is an placeholder for the purposes of estimating workshop costs)

[2515] Eating Swallowing

Select PRACTICUM PRICE for this Workshop

if "other," only enter dollar amount, not workshop name. Ex., enter "$5"

Three Part Treatment Plan for OPT = $5 per participant

OPT: Assessment and Program Plan Development = $10 per participant

Is it CAS? Differential Diagnosis and Treatment = $25 per participant

Eating Swallowing: A Global Approach = $15 per participants

Taking Your Client with Autism from Non-Vocal to Verbal = $5 per participant

(Level Three - included in the workshop costs) = $0

(Level Four - included in the workshop costs) = $0

Other

Estimated Practicum Costs

Instructor Travel Terms(Required)

Workshop Partner agrees that TalkTools arrange and pay for airfare based on air travel estimates Workshop Partner submits through Workshop Travel Form. TalkTools will invoice Workshop Partner for Instructor air travel

During the Instructor's stay for this Workshop, Workshop Partner agrees to pay and arrange for hotel accommodations, meals and transportation at reasonable rates

Workshop Partner will invoice TalkTools for these costs, as part of the final invoice (due to TalkTools within 10 days of the workshop dates)

Estimated Air Travel(Required)

Estimated Total Workshop Costs

honorarium/speaker fee+estimated practicum if purchasing+any other required kits+estimated air travel if workshop is in-person

Gravity Form to e-signature-International Workshops (Hill)

Today's Date

Workshop 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)

3-Part Treatment Plan for OPT (Level 1 requirement)

OPT: Assessment and Program Plan Development (Level 1 requirement)

Is it CAS (Childhood Apraxia of Speech)? Differential Diagnosis and Treatment (Level 2 elective)

Eating and Swallowing: A Global Approach to Feeding (Level 2 elective)

Taking Your Client with Autism from Non-Vocal to Verbal (Level 2 elective)

Level 3 (Note: there is an addendum for this course and will be sent after this agreement is signed)

Level 4 (Note: there is an addendum for this course and will be sent after this agreement is signed)

Workshop Instructor(Required)

Renee Roy Hill = $3500 per day

Renee Roy Hill = $3500 Eating Drinking Swallowing Day One ONLY

What format is this workshop(Required)

Virtual/Streaming

Live/In-Person

If this workshop is virtual, will TalkTools or the Workshop provide the virtual meeting platform (i.e., Zoom)

TalkTools will provide the virtual meeting platform

Workshop Partner will provide the virtual meeting platform

Start Date(Required)

End Date(Required)

Total Number of Days(Required)

Start Time(Required)

each day

AM/PM

End Time(Required)

each day

AM/PM

Workshop Venue Name and Address

Workshop Venue/Location POC(Required)

VIRTUAL OR IN-PERSON: first name, last name

Workshop POC email(Required)

Estimated Number of Participants(Required)

Total Honorarium/Speaker Fee for this workshop

Deposit Amount

Deposit 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)

No -- Workshop Partner has the supplies and will assemble the practicum

Yes -- Workshop Partner needs to order practicum kits

Practicum/Hands-On Learning Supplies(Required)

PLEASE REVIEW THE PRACTICUM LIST FOR THIS WORKSHOP - https://talktools.com/pages/live-workshop-practicum

I have reviewed the practicum list

I agree to provide practicum for each workshop participant

Select PRACTICUM SKU for this Workshop

[3801] Three Part Treatment for OPT (Oral Placement Therapy

[3803] OPT: Assessment and Program Plan Development

[3808] Is it CAS? DIfferential Diagnosis and Treatment

[3815] Taking Your Client with Autism from Non-Vocal to Verbal

[3816] Level 3 (included in the workshop costs)

[3816] Level 4 (included in the workshop costs)

Other (this is an placeholder for the purposes of estimating workshop costs)

[2515] Eating Swallowing

Select PRACTICUM PRICE for this Workshop

if "other," only enter dollar amount, not workshop name. Ex., enter "$5"

Three Part Treatment Plan for OPT = $5 per participant

OPT: Assessment and Program Plan Development = $10 per participant

Is it CAS? Differential Diagnosis and Treatment = $25 per participant

Eating Swallowing: A Global Approach = $15 per participants

Taking Your Client with Autism from Non-Vocal to Verbal = $5 per participant

(Level Three - included in the workshop costs) = $0

(Level Four - included in the workshop costs) = $0

Other

Estimated Practicum Costs

Instructor Travel Terms(Required)

During the Instructor's stay for this Workshop, Workshop Partner agrees to pay and arrange for hotel accommodations, meals and transportation at reasonable rates

Workshop Partner will invoice TalkTools for these costs, as part of the final invoice (due to TalkTools within 10 days of the workshop dates)

Estimated Air Travel(Required)

Estimated Total Workshop Costs

honorarium/speaker fee+estimated practicum if purchasing+any other required kits+estimated air travel if workshop is in-person