Gathering Workshop Application | Bereaved Parents of the USA

First Name *

Last Name *

Phone

Email

Street Address

Address Line 2

City

State

Zip

Please fill in all categories that apply to you, not just the one you would speak about:

Bereaved Parent

Bereaved Grandparent

Bereaved Sibling

Professional

Other

In the spaces below, provide information for up to three children/siblings/grandchildren. If there are more, please include in the Additional Information section.

Child/Grandchild/Sibling Name (first and last):

Is this a...

If other please explain (stepson, cousin, etc.)

Date of Birth

Date of Death

Cause of Death

Child/Grandchild/Sibling Name (first and last):

Is this a...

If other please explain (stepson, cousin, etc.)

Date of Birth

Date of Death

Cause of Death

Child/Grandchild/Sibling Name (first and last):

Is this a...

If other please explain (stepson, cousin, etc.)

Date of Birth

Date of Death

Cause of Death

Additional Information

I will be available to present my workshop and/or repeat my workshop at any of the following sessions (please check all that apply):

Friday AM

Friday PM

Saturday AM

Saturday PM

Willing to Repeat Workshop

Not Willing to Repeat Workshop

Are you willing to facilitate a Sharing Session?

Friday Night

Saturday Night

Your Bio: In a short paragraph of 60-120 words, please introduce yourself by giving information about your grief experience and credentials. You may include your website, if applicable. Please be aware we may need to edit the information you provide in the interest of brevity or clarity. We will use this paragraph in the Gathering Program.

Each workshop presentation will be 50 minutes in length including Q&A. Attendees appreciate handouts. Plan for a minimum of 30 handouts per workshop.

Preferred Title of Workshop

Workshop Topic

Basic Structure of Workshop: Please give us an idea of what your workshop is about and the information you will be presenting to the attendees. Explain the basic structure of the workshop with specific details. Past attendees have asked for more specific information on certain workshop topics. Please indicate below if your workshop will contain references to: ADC’s (After Death Communications) or Religion.

Brief Description: Please provide a brief description of your workshop (50-100 words) Please be aware that we may need to edit the information you provide in the interest of brevity or clarity. We will use this paragraph in the Gathering Program.

Room Setup: Let us know of any special requests for room set up, e.g., Classroom, Theater, Circle, etc.

Important A/V note: BPUSA will do our best to accommodate your request, but we can’t guarantee A/V access for every room. Please indicate your preference below:

I will use a projector for my presentation

I won’t be using a projector

I am flexible and will use a projector only if one is available

Other Request(s) or Comments.

BPUSA Gathering Conference

Workshop Presenter Application

After you submit your application, you will receive an immediate copy by email.