AuSM Training Confirmation

This form is to confirm final details to you and AuSM's Education staff about your upcoming AuSM training. The receipt for this form will function as your contract. Please retain the confirmation email. If you have any questions, please contact the Education Department at 651.647.1083 ext. 22.

Name*

First Last

Phone*

E-mail*

Organization

Venue of training (include room name or number if known)

Address*

Street Address Address Line 2 City State ZIP Code

Day of training contact*

First Last

Contact e-mail*

Contact phone*

Who will be attending? (Parents, paraprofessionals, police, etc.)

Estimated number of attendees

Training Topic

Presented by (if you did not discuss a specific presenter, put AuSM)

Date(s) and time(s) of training

Total hours of training

Please enter the agreed upon cost of the training.*

Please check which of the following technologies and materials you need AuSM to provide.

Projector or screen to display presentation
Computer to run presentation
Register participants to attend the event (may incur additional fees)
Advertisement of the event (may incur additional fees)
Flash Drive with presentation included
Email presentation file ahead of time

If you selected "e-mail presentation ahead of time", please specify the date the file is due.

Please add any additional information or questions about technology.

AuSM typically invoices after a training has been completed. If you would like to be billed at an earlier date, please specify here.

Billing contact*

First Last

Title

E-mail*

Phone*

Billing address*

Street Address Address Line 2 City State ZIP Code

Do you agree to the terms below?*

I agree

-Please note that cancellations within two weeks of the training date are subject to a $100 cancellation fee. -If travel outside the Twin Cities 7 County Metro Area is required for the presentation, a fee of $0.56 per mile will be added to the hosting party's final invoice. -If hotel accommodations are required because of travel to the location, the hosting party agrees to pay for reasonable accommodations. -The hosting party grants confirmation that any material presented will not be used or redistributed without the consent of the Autism Society of Minnesota.

AuSM Training Confirmation

AuSM Training Specifications and Confirmation