Speaker Name
              
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                    First Name 
                   
                
                
                  
                    Last Name 
                   
                
               
            
            
            
            
            
            
        
          
          
            
            
            
              
                
            
              Speaker Title
              
                * 
              
             
          
                
                
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
              
                
            
              Company Name
              
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              Address
              
                * 
              
             
          
                
                
                  
                    Address 1 
                   
                
                
                  
                    Address 2 
                   
                
                
                  
                    City 
                   
                
                
                  
                    State/Province 
                   
                
                
                  
                    Zip/Postal Code 
                   
                
                
                  
                    Country 
                   
                
               
            
            
            
        
          
          
            
            
            
            
            
              
                
            
              Email Address
              
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              Phone
              
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                    (###) 
                   
                
                
                  
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              What amenities do you need for your workshop (electricity, water, stovetop, etc.)? 
              
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              How do you envision your students sitting (chairs in rows, chairs at tables, on the ground, etc.)?
              
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              Please list any other special needs for this workshop? If none, please write "none". 
              
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              Will you be bringing an assistant? Please note that we do have interns available to assist you if you need one.
              
                * 
              
             
          
                
                
                
                  
                    Yes 
                  
                    No 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
              
                
            
              If yes, what is your assistants name?
              
             
          
                
                
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
              
                
            
              What is Your Favorite Herb, and why? 
              
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              Please offer a recipe or other way to use your favorite herb
              
                * 
              
             
          
                used for marketing purposes
                
               
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Would you like a complimentary booth in the Marketplace?
              
                * 
              
             
          
                
                
                
                
                
                
               
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Would you like a 1/2 table space in the Teacher's Tent?
              
                * 
              
             
          
                Maximum space in the Teacher's Tent is 1/2 table, and is to be used for promotional material, book sales, or small amounts of product sales.  If you would like to sell or promote more than that, please take advantage of a free full booth space.
                
                
                
                
                
               
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              FRIDAY NIGHT RECEPTION & SATURDAY NIGHT DINNER: We encourage you to attend the Friday night reception and the Saturday evening dinner. Both are included in your speaker’s compensation package. Please mark the events you will join us for.
              
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              Please consider donating to assist with the operational cost  of Botanica in one of the following ways.
              
             
          
                Please check those that you are able to do:
                
                
                
                
                
               
            
            
            
            
            
            
            
            
        
          
          
            
            
              
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
         
      
      
      
      Thank you for submitting your answers to our questionnaire. Please email Sara Martinelli (sara@threeleafconcepts.com ) your preferred speaker photo for the Botanica speaker page. 
Thank you again. We can’t wait for the Festival. See you soon.
The Botanica Festival Team