Work with Ms. Ussin
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Event Contact Person *
Contact Person's Title *
Contact Person's Email *
School / District / Organization / Conference *
This event is __________________. *
Event Address (Include City, State and Zip Code)
Nearest airport?
What date do you wish to have Ms. Ussin share with your teachers/staff? *
MM
/
DD
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YYYY
In what capacity will Ms. Ussin be serving? *
How much time will be allotted for Ms. Ussin to share with your teachers/staff? *
Approximately how many teachers/staff/participants will be in attendance? *
Are there any specific issues/concerns/needs/topics that Ms. Ussin should address? Please explain in detail. *
What would you like your teachers to receive from their time with Ms. Ussin? Be as detailed as possible. *
Will Ms. Ussin have access to Wifi? *
Will Ms. Ussin have projection capability to share a Prezi or PowerPoint presentation? *
If there is projection capability, will Ms. Ussin need her own laptop and cables or will those things be provided? *
Will Ms. Ussin's assistant be allowed to capture still shots and video throughout the session? *
If you answered "Maybe" to the previous question, please explain in detail.
Is your school/organization able to provide quality (professional) videography coverage of Ms. Ussin's presentation/workshop? *
If you answered "Maybe" to the previous question, please explain in detail.
How did you learn of Ms. Ussin? *
What is your budget for this session? *
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