EmailMe Form - Social Work Month Event Planning Form

UNIT: *

Big Bend

Broward

Central

Emerald Coast

North Central

Heartland

Lake/Sumter

Miami-Dade

Nature Coast

Northeast

Northwest

Northwest - Ft. Walton

Palm Beach

Palm Beach - North

Palm Beach - South

Sarasota/Manatee

Southwest

Space Coast

Tampa Bay

Treasure Coast

Volusia/Flagler

Event Type and Details:

Please provide the kind of Social Work Month (SWM) event, date of the event and start / end times.

WHAT KIND OF EVENT: *

SWM Celebration

SWM Celebration and Awards

SWM Celebration, Awards and CE Workshop

SWM Celebration and CE Workshop

SWM Celebration and Fundraiser

SWM Celebration, Awards, CE Workshop, Fundraiser

WHAT DATE IS YOUR SWM EVENT?

MM / DD / YYYY

EVENT START TIME: *

HH : MM AM/PM

EVENT END TIME: *

HH : MM AM/PM

SWM Event Location:

SWM Event Address:

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Event Advertising and Registration:

Please provide your marketing and registration details.

ADVERTISING/MARKETING: Please create and send out the following items: *

ONLINE REGISTRATION FOR ATTENDEES: *

Yes

No

Pre-Pay Only

On-Site Payment Allowed

CLOSE ONLINE REGISTRATION FOR ATTENDEES ON A SPECIFIC DATE?

Yes

No

IF YES, WHAT DATE IS REGISTRATION TO CLOSE?

MM / DD / YYYY

ONLINE REGISTRATION FOR SPONSORS: *

Yes

No

Pre-Pay Only

Onsite Payment

IF YES, WHAT DATE IS SPONSOR REGISTRATION TO CLOSE?

MM / DD / YYYY

Please give full information about your SWM event. Please include any SPECIAL details that should be included in marketing materials.

SWM CE Workshop Information:

Please provide your SWM Workshop Details. This includes, contact person, where to send the CE Packet, objective(s) and presenter(s) resume(s).

FOR CE WORKSHOPS, PLEASE COMPLETE THE FOLLOWING:

Title of Workshop:

Presenter Name and Credentials:

Workshop Location if Different from SWM Event Location:

Workshop Address if Different from SWM Event Address:

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Suggested Number of Contact Hours (NASW-FL will make final determination):

Contact Person for Workshop: *

First Last

Contact Person's Email Address:

Contact Person's Phone Number

### - ### - ####

Mailing Address to Send CE Packet - Please Complete This Section In Entirerty:

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

To have CE credit approval for this workshop, the presenter's CV/resume and at least one learning objective per contact hour sought must be included with this planning form.

The learning objective(s) for this workshop is / are:

Upload Presenter CV / Resume:

SWM Registration Fees - Please provide your SWM registration costs.

Registration Fees (include rates for member/non-member; other rates optional): *

Do Award Winners Attend for Free? *

Yes

No

Can Award Winners Bring a Guest for Free? *

Yes

No

Will Your Unit Leadership Attend for Free? *

Yes

No

SWM Venue Contract: Please include the venue contract if available at this time.

Are there any costs that will be associated with this event, such as venue, catering, presenter honorarium, or supplies? If so, please list them here. A separate check request form must be completed when payment needs to be sent.

Special Request: Please list all specific requests you have for this event. Some examples are: A reminder sent on a specific date; online registration counts provided on a certain date; or sponsors added to the marketing materials.

SWM Awards and Certificates - Please provide SWM award and certificate details.

Do you want NASW-FL Chapter Office to order your SWM Awards? *

Yes

No

If yes, please provide the winners names, credentials and what award the person won if you have that information. If not, please provide an anticipated date when you will have this information.

Do you want NASW-FL Chapter Office to create Certificates of Appreciation? *

Yes

No

If yes, please provide the names and credentials for the Certificates of Appreciation. If you do not know at this time, please provide an anticipated date when you will have this information so we can follow up with you.

SWM Event Printing Needs - Please provide SWM printing, badges, tickets, etc.

Do you want NASW-FL Chapter Office to Create and Print a SWM Program for Your Event? *

Yes

No

Do you want NASW-FL Chapter Office to Create and Print Name Badges for Your SWM Event? *

Yes

No

Do you want NASW-FL Chapter Office to Create and Print Name Tents for Your SWM Event? *

Yes

No

Do you want NASW-FL Chapter Office to Create and Print Signs for Your SWM Event? *

Yes

No

If yes, please provide details about the signs you want - Size, quantity, etc..