Bereaved Parents of the USA

Workshop Presenter's
Online Application

Please complete all applicable questions, those marked with a red asterisk ( * ) are required fields. Thank you.

Name *
email address *
Address
City
State
Zip Code
(please use numbers only, i.e. 1234567890 for phone numbers)
Home Phone *
Cell Phone
Are you planning to attend for the entire weekend or just for your specific workshop: *

I would be willing to repeat this workshop on Friday or Saturday: Yes No *

I would be willing to facilitate a sharing session on Friday or Saturday evening: Yes No
If you are a Bereaved Parent (Please fill in all categories that apply to you, not just the one you would speak about)
Child's Name(s) (first and last)
Date of Birth
Date of Death
Cause of Death

Grandchild's Name (s) (first and last)
Date of Birth
Date of Death
Cause of Death

Brother's or Sister's Name(s) (first and last)
Date of Birth
Date of Death
Cause of Death

Your Grief Experience (In 4-5 sentences, please tell us about your grief experience as related to this workshop.)

This section is to give the workshop committee an idea of what your workshop is about and the information you will be presenting to the attendees. The objective and issues addressed portions are particularly important to the committee.
Suggested Title:

Topic:

To whom is this workshop directed?

This is a 50 minute presentation, including Q&A (check box)
Objective of workshop:

Issues addressed:

Handouts - plan for a minimum of 40 for a one time workshop
Wrap up - how attendees can apply what they have learned in your workshop:

Please Note that workshops may be videotaped for future use by chapters to view and share with their members! If you are NOT willing to have your workshop taped, please check here
Comments/Questions

2008 Gathering home

2008 Registration
  Packet
  Packet
  Butterfly

Contact Information
Hotel
Leadership Workshops Meals
Speakers
Workshops
Butterfly Boutique
Bookstore

25 things to do in
St. Louis

For more information check out the registration packet

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Workshop Presenters
Online Application

Workshop Presenters Application