Bereaved Parents of the USA
2012 Gathering
Gathering 2012
Now Available

Hotel Registration
Information

Workshop Presentor Application
MS Word Word | PDF pdf
Online Application

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to the 2012 Gathering


Workshop Presenter's Online Application

Please answer all applicable questions. Those questions marked with a red asterisk ( * ) are required fields. Thank you.

The gathering committee will notify you as soon as possible whether your proposed workshop has been accepted. However, the actual day and time that your workshop is scheduled may not be final until shortly before the gathering. If you have a need for your workshop to be scheduled on a certain day or time, please let us know and we will attempt to accommodate your request.

Note that we may need to edit the information you provide in order to accommodate the constraints of the Program Book.

Book Sales: All book sales must be done through the Gathering Bookstore, managed by The Centering Corporation. If you are the author of a book for sale, you may contact Janet at The Centering Corporation to inquire about having your book made available at the gathering bookstore. 866-218-0101 or janet@centeringcorp.com

Please Note: At past gatherings, attendees have noted on evaluation forms that repeated reference to an author’s book during a workshop is a definite “turn off.” We request if you have a book, that you mention it at the beginning of the workshop, tell the attendees that it is available at the gathering book store, and not keep referring back to it.

AV Equipment: Please note that the gathering committee may not be able to provide audio/visual equipment. If your workshop requires A/V equipment, you may need to provide your own.

 If you would prefer a print copy to complete and mail -
Click here to download the pdf Workshop Application
and Click here to download the MS Word Workshop Application Word

Name *
Email Address *
Address
City
State
Zip Code
(please use numbers only, i.e., 1234567890 for phone numbers)
Home Phone *
(Please give us your cellphone number in case we need to reach you during the gathering days.)
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 *
           
I will be available to present my workshop and/or repeat my workshop at any of the following sessions: *
                  
I would be willing to facilitate a sharing session on Friday or Saturday evening
           

If you are a Bereaved Parent
(Please provide information for all of the following categories that apply to you,
not just the one about which you will be speaking.)
If you are a Bereaved Parent, please indicate your Child(ren)'s Names (first and last), and for each the Date(s) of Birth and of Death, and the Cause(s) of Death
If you are a Bereaved Grandparent, please indicate your Grandchild(ren)'s Names (first and last), and for each the Date(s) of Birth and of Death, and the Cause(s) of Death
If you are a Bereaved Sibling, please indicate your Brother's or Sister's Name(s) (first and last), and for each the Date(s) of Birth and of Death, and the Cause(s) of Death
Your Bio *
In a short paragraph (e.g., 4-5 sentences), please provide your bio including information about your grief experience and other credentials as they relate to this workshop. We will use this paragraph in the Gathering Program Book. We reserve the right to edit the paragraph to fit within the constraints of the Program Book.

Proposed Workshop Description *
This description provides the workshop committee with an idea of what your proposed workshop is about and the information you will be presenting to the attendees. We will use this information for a description of your workshop in the Program Book. We are particularly interested in the objectives of, and the issues addressed in, your proposed workshop. We reserve the right to edit the description to fit within the constraints of the Program Book.

All workshops last a total of one hour. We urge you to build at least 10 minutes into your workshop for questions and answers.

If you intend to provide handouts at your workshop, please bring at least 30 copies per workshop.
Suggested Workshop Title: *
Workshop Topic: *
To whom is this workshop directed? *
Objective of workshop: *
Issues addressed: *
Wrap up - how attendees can apply what they learn in your workshop: *
May we video-record your workshop for our chapters to use in their meetings?
           
Comments/Questions
Note here if you have a particular need for your workshop to be scheduled on a particular day or at a particular time. Also note any A/V equipment you would like to request. Note any special requirements you might have for your workshop which are not covered in the questions above.

Thank you for applying to be a workshop presenter
at the upcoming BP/USA National Gathering.