Bereaved Parents of the USA

Workshop Presenter's
Online Application

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

Notification of workshop acceptance will begin in January. The actual day and time that a particular workshop is scheduled will not be available until immediately before the Gathering. If you have an overriding 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.

Please be aware that we may need to edit the information you provide in the interest of brevity or clarity.

If you are the author of a book for sale, you may contact Janet at Centering Corporation to inquire about having your book available in the Gathering Bookstore. They are managing the book store this year and Janet may be reached at janet@centeringcorp.com or by calling 1-866-218-0101.

If you would prefer a print copy to complete and mail -
click here for the Workshop Application.

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?

Objective of workshop

Issues addressed

Wrap up - how attendees can apply what they have learned in your workshop

May we have your permission to video your workshop for future use by chapters to view and share with their members! Yes No
Each workshop is 45 minutes long with 15 minutes for Q&A. It is your responsibility to provide or bring any equipment you need to present your workshop (e.g., projector). If you intend to distribute any handouts at your workshop you should be prepared with 40 copies (minimum) per workshop.
Comments/Questions

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

You will be notified by the workshop committee if your application has been accepted or not.

Gathering 2011

Speaker Application
Word | PDF

Workshop Presenter Application
Word | PDF
Online

Deadline for submission of speaker applications is Sept. 30, 2010