Workshop Booking and Contracting Form - Renee Roy Hill Today's Date051234567891011122812345678910111213141516171819202122232425262728293031202220232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Workshop Partner Full Name (First Name and Last Name)(Required) Workshop Partner Organizaton(Required) Workshop Partner email(Required) Workshop Partner Organization Street Address(Required) Workshop Partner Organization City(Required) Workshop Partner Organization Country(Required) Workshop Course(Required) Level 1: Three Part Treatment Plan for OPT Level 2: OPT: Assessment and Program Plan Development Is it CAS? Or Something Else: Diagnosis and Treatment (updated Sensory Motor Approach to Apraxia) 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) Taking Your Client with Autism from Non-Vocal to Verbal Other Workshop Instructor Renee Roy Hill = $3500 per day (SPECIAL FEE) Renee Roy Hill = $1750 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)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 Workshop Venue Name and Address Workshop Venue/Location POC(Required)VIRTUAL OR IN-PERSON: first name, last name Workshop Partner agrees to be responsible for any catering during the workshop I agree 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) 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(Required) [3801] Three Part Treatment for OPT (Oral Placement Therapy Practicum (Level 1) [3803] OPT: Assessment and Program Plan Development Practicum [3808] Is it CAS? Or Something Else? 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) Select PRACTICUM PRICE for this Workshop(Required) Three Part Treatment for OPT (Oral Placement Therapy Practicum (Level 1)= $8/person OPT: Assessment and Program Plan Development Practicum (2)= $17/person Is it CAS? Or Something Else? Diagnosis and Treatment =$35/per participant Taking Your Client with Autism from Non-Vocal to Verbal = $8 per participant Level 3 (included in the workshop costs) Level 4 (included in the workshop costs) Other = $8 per person (this is an placeholder for the purposes of estimating workshop costs) Estimated Practicum CostsInstructor 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 Costshonorarium/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 Date051234567891011122812345678910111213141516171819202122232425262728293031202220232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Workshop Partner Full Name (First Name and Last Name)(Required) Workshop Partner Organizaton(Required) Workshop Partner email(Required) Workshop Partner Organization Street Address(Required) Workshop Partner Organization City(Required) Workshop Partner Organization Country(Required) Workshop Course(Required) Level 1: Three Part Treatment Plan for OPT Level 2: OPT: Assessment and Program Plan Development Is it CAS? Or Something Else: Diagnosis and Treatment (updated Sensory Motor Approach to Apraxia) 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) Taking Your Client with Autism from Non-Vocal to Verbal Other Workshop Instructor Renee Roy Hill = $3500 per day (SPECIAL FEE) Renee Roy Hill = $1750 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)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 Workshop Venue Name and Address Workshop Venue/Location POC(Required)VIRTUAL OR IN-PERSON: first name, last name Workshop Partner agrees to be responsible for any catering during the workshop I agree 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) 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(Required) [3801] Three Part Treatment for OPT (Oral Placement Therapy Practicum (Level 1) [3803] OPT: Assessment and Program Plan Development Practicum [3808] Is it CAS? Or Something Else? 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) Select PRACTICUM PRICE for this Workshop(Required) Three Part Treatment for OPT (Oral Placement Therapy Practicum (Level 1)= $8/person OPT: Assessment and Program Plan Development Practicum (2)= $17/person Is it CAS? Or Something Else? Diagnosis and Treatment =$35/per participant Taking Your Client with Autism from Non-Vocal to Verbal = $8 per participant Level 3 (included in the workshop costs) Level 4 (included in the workshop costs) Other = $8 per person (this is an placeholder for the purposes of estimating workshop costs) Estimated Practicum CostsInstructor 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 Costshonorarium/speaker fee+estimated practicum if purchasing+any other required kits+estimated air travel if workshop is in-person
