Proposal Submitted By

Your Name

Your E-Mail

Workshop Information

Workshop Code

Workshop Title

Sponsoring Commission

Commission Contact

Contact E-Mail

Number of Days

Start Day

Start Time (1st day)

End Time (1st day)

Start Time (2nd day)

End Time (2nd day)

Location

  If offsite, where 

Approved By

Min. Participant Enrolment

Max. Participant Enrolment

Participant Fee

Program Description for Session

(Please include the type of program you are presenting. Limit: 500 characters)

Personnel Information *

Session Chair

Non-USITT **

Address

 

 

 

Phone (Work)

Phone (Home)

Fax

E-Mail

Additional Panelists

Panelist 1 Name

Non-USITT **

Address

Phone (Work)

Phone (Home)

Fax

E-Mail

Panelist 2 Name

Non-USITT **

Address

Phone (Work)

Phone (Home)

Fax

E-Mail

Panelist 3 Name

Non-USITT **

Address

Phone (Work)

Phone (Home)

Fax

E-Mail

Panelist 4 Name

Non-USITT **

Address

Phone (Work)

Phone (Home)

Fax

E-Mail

Panelist 5 Name

Non-USITT **

Address

Phone (Work)

Phone (Home)

Fax

E-Mail

Panelist 6 Name

Non-USITT **

Address

Phone (Work)

Phone (Home)

Fax

E-Mail

* Please submit program participant's biographies form for all panelists and forward to Commission Contact Person. Maintain a copy of each form for your records.

** Checking the 'non-USITT' box does not generate the Non-Member Guest registration. You must complete the Non-Member Guest registration form for non-member presenters, unless you are also requesting housing or travel for that guest.

Requirements

Room Configuration

Note: Theatre/Panel is the standard configuration.

Theater/Panel
Theater / Panel
 Classroom
Classroom
 Hollow Square
Hollow Square
# of Presenters /
Participants 		Reception
Reception Layout
Tables along
walls
Tables Along Walls
# required 		Other

Describe
your needs
in the notes
area below.

Notes

Technical Requirements

A/V Equipment is EXPENSIVE. Please be sure of your requirements.

Computer Stand Alone DVD Player Props / Other (specifiy below)
    PC   or MAC Slide Projector
    USITT supplied  or Personal Overhead Projector
    Internet Video Camera
    Audio Playback Laptop VHS
  White Board

Professional Development Workshop Budget Worksheet

Supplies
Description Quantity Price Total
(A)
(A)
(A)
(A)
Presenter/Panelist 1
Travel Travelling From (B) Travel Cost
Accomodations # of Nights Cost Per Night (C) Accom. Total
Honorarium SSN (D) Honor. Amount
Presenter/Panelist 2
Travel Travelling From (B) Travel Cost
Accomodations # of Nights Cost Per Night (C) Accom. Total
Honorarium SSN (D) Honor. Amount
Presenter/Panelist 3
Travel Travelling From (B) Travel Cost
Accomodations # of Nights Cost Per Night (C) Accom. Total
Honorarium SSN (D) Honor. Amount
Presenter/Panelist 4
Travel Travelling From (B) Travel Cost
Accomodations # of Nights Cost Per Night (C) Accom. Total
Honorarium SSN (D) Honor. Amount
Presenter/Panelist 5
Travel Travelling From (B) Travel Cost
Accomodations # of Nights Cost Per Night (C) Accom. Total
Honorarium SSN (D) Honor. Amount
Presenter/Panelist 6
Travel Travelling From (B) Travel Cost
Accomodations # of Nights Cost Per Night (C) Accom. Total
Honorarium SSN (D) Honor. Amount
Site Expenses
Type Estimated Cost
(E)
(E)
(E)
(E)
Audio Visual Expenses
Type Estimated Cost
(F)
(F)
(F)
(F)
Special Expenses
Type Estimated Cost
Food : # meals * $25 per participant (G)
Food : # breaks * $15 per participant (G)
Transportation (Full Bus = $800) (G)
Summary
Income Expense
Minimum # of Participants N Supplies Sum A boxes
Suggested Participant Fee FEE Travel Sum B boxes
Total = N x FEE TOTAL Accommodations Sum C boxes
    Honoraria Sum D boxes
    Site Expenses Sum E boxes
    AV Expenses Sum F boxes
    Special Expenses Sum G boxes
    Expenses Subtotal (H) Sum A-G
    Overhead (I) 25% of Line H
    Contingency (J) 15% of Line H
    Total Expenses Sum lines H + I + J