First Name

Last Name

Name of Organization

Email

Phone Number

Website

Address

City

State

Postal Code

Country

List any deadlines

Organization's mission

Conference location

Anticipated number of attendees

List all commitments you would like considered. (ex: 1 day, workshop from 9-3, anytime time year, etc.)

Theme/title of the conference

Describe what you would like Dafna to teach

List other key instructors who might be teaching at the workshop

Attach brochure from last year

Share any comments

Request a Workshop with Dafna

Workshop Request