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

Copyright ©2006 Michael Miller. All rights reserved.