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Chapter Event Worksheet
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2020-01-27T00:40:22-05:00
Chapter Event Worksheet
Please fill out the Chapter Event Worksheet for your upcoming event. Your event plans will be reviewed and a region workforce coordinator will be in contact within 3 business days to go over and finalize details.
Chapter Hosting the Event
*
Central Region
Columbus Region
East Central Region
Evansville Region
North Central Region
North Eastern Region
North Western Region
Northern Region
South Central Region
South Eastern Region
West Central Region
Name of Event
Local Chapter Contact for Registration
Contact Email
Contact Phone
Is Another Chapter Co-Sponsoring the Event?
Yes
No
Co-Sponsoring Chapter
Central Region
Columbus Region
DAWN Region
Dunes Region
East Central Region
Evansville Region
North Eastern Region
North Western Region
Northern Region
South Central Region
South Eastern Region
Tippecanoe County Region
West Central Region
Whitewater Valley Region
Are any outside organizations sponsoring the event?
If there are outside organizations sponsoring the event we will need the logo of the organization as well as some additional information. You will be contacted if there are further questions.
Yes
No
Date of Event
MM slash DD slash YYYY
Event Start Time
:
AM
PM
AM/PM
Event End Time
:
AM
PM
AM/PM
Event or Meeting
*
Meeting
Event
Event type
*
Face to Face/In person
Remote/online
Hybrid
What media platform is preferred?
Event Location
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Any additional details on location
Anticipated Attendance
Maximum Attendance
Member Rate
Non-Member Rate
Additional Rate Information
Please include any early bird discounts or additional rate categories
Will there be early bird rates?
Yes
No
Early Bird Deadline
MM slash DD slash YYYY
Is lunch included with Conference
Yes
No
If yes, please list if they have choices or if they can indicate if they have dietary restrictions
Are there any additional questions that need to be asked during the registration process?
Yes
No
If yes, please identify questions to be asked
Will training hours be provided?
*
Yes
No
If yes, identify the CKC(s) that align with this training
*
Event Details
Please be as specific as possible on the details of the event. Include things such as topics covered, presenters, highlights, bios. This information will be used in the creation of flyers and marketing materials.
Additional Resources
NAEYC Membership Brochures
T.E.A.C.H. Early Childhood ® INDIANA
Accreditation Brocures
Non-formal CDA Brochures
** These must be requested at least 4 weeks in advance and will be based on resources available at time of request
How many NAEYC Membership brochures?
How many T.E.A.C.H. Early Childhood ® INDIANA brochures?
How many Accreditation brochures?
How many Non-Formal CDA brochures?
Thank you! We look forward to working with you on your event!
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