Workshop Booking Form – Host

Host's Name *

Presenter's Name *

Organization or Club Name (if applicable) *

Website

Host's Email Address *

Host's Phone (internal use only) *

Host's Address

Alternate or Emergency Contact *

Location of Course (city, state) *

Date, Time and Course Title *

Date, Time and Course Title (Day 2 if applicable)

Date, Time and Course Title (Day 3 if applicable)

Any additional information you would like to share with us

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