Michael Miller Pilates makes sense SM

Workshop Request Form

	The plan is to make is a form you can fill out and submit on the web. I'm still learning the technicals on that, so please print and fill out this form as best you can, and mail it in with your booking fee.
Which instructor are you requesting?
Which time slots are you requesting?
FEES
Booking fee (for confirmation) $1,000 USD
Travel, accomodations
Flat rate
Flat rate maximum attendees
Percentage split (instructor/host) for attendees beyond those covered by flat rate.
Balance due (Flat rate upon arrival (cash or traveler's checks) Percentage split before departure of instructor. See further terms and conditions below.*

HOST INFORMATION
First name
Last name
Address line 1
Address line 2
City
State
Country
Zip
Phone
Phone cellular
Phone fax
Pager
Voice mail / Info line
Email address
Web address
Have you ever worked with a Michael Miller Pilates instructor in the past? Who?
Have you ever hosted your own event? Where and when?
What other instructors have you worked with in the past?
What other instructors do you have confirmed?
What other instructors have you placed bids for?
In the event of emergency, please list name, address, and phone number of the person(s) who are assisting you with this event.
Total performance compensation you are offering the instructor. (Travel, Accommodations & Booking Fee NOT included)
PROFESSIONAL REFERENCES
Please list the names, phone numbers & email addresses for a minimum of three established references:
Reference #1
Reference #2
Reference #3
EVENT LOCATION
Organization name
Organization Address line 1
Organization Address line 2
Organization City
Organization State
Organization Country
Organization Zip
Organization phone
Organization fax
Organization email address
Organization web address
Number of attendees expected
Fee structure
Liability insurance supplier (name and phone)
INSTRUCTOR TRAVEL ITINERARY
Note: Please fill out this form entirely.
Instructor name
Start time
Balance due
DESIGNATED DRIVER INFORMATION
Name of driver / company
Address
Phone, Cell, Pager #
License plate #
Color, make, & model of transport
HOTEL INFORMATION
Name of Hotel
Hotel address
Hotel phone & fax numbers
Hotel sales representative
FLIGHT INFORMATION
Name of airline
Phone of airline
Web site of airline
Name of airport
Phone of airport
Flight Itinerary (please supply actual travel agent hard copy)
PLEASE SUPPLY ANY ADDITIONAL INFORMATION THAT MAY BE NEEDED

*TERMS AND CONDITIONS

This Event Agreement and deposit must be received by Michael Miller Pilates, upon receipt of which the event will be confirmed. This deposit is NON REFUNDABLE except under the following conditions:

1. If the instructor agrees in writing that a refund is to be made.

2. If the host cancels the booking in writing, and the instructor is re-booked for the same period of the original booking (complete refund of deposit), or if re-booked for only a portion thereof, the refund with be made on a pro-rata basis.

3. If there is a change in instructor and the host wished to cancel for this reason.

FLAT RATE PAYMENT IS DUE PRIOR TO EVENT, PERCENTAGE SPLIT PAYMENT IS DUE PRIOR TO DEPARTURE OF INSTRUCTOR, AND IS TO BE PAID TO INSTRUCTOR. THIS PAYMENT IS TO BE MADE IN THE FORM OF TRAVELER'S CHECKS OR CASH.

Host agrees if instructor is unable to appear due to circumstances beyond their control, for instance, acts of god, airline strikes, armed conflict, ALL deposits are NON REFUNDABLE, and any partial performance of event will be refunded on a pro rata basis.

NOTE: All fees do not include gratuities to instructor, event materials or equipment.

Michael Miller
Michael Miller Pilates
75 Benthaven Place
Boulder, CO 80305
USA
303-488-8228
303-588-8080 cell
michaelmillerpilates skype
michaelmiller@hermit.com