Name:________________________________________________________________________________

Address: _______________________________________________________________________________

City:_______________________ State/Prov: ________________ Zip: __________Country: ___________

Phone: ________________________________ email: _________________________________________

Number of years you have been teaching organized classes* ___________________________________

* conventions, conferences, workshops etc, planned by an organized group

List by preference, techniques you teach (up to five).

1st _______________________________________

2nd _______________________________________

3rd _______________________________________

4th _______________________________________

5th _______________________________________

List any slide, lecture or other presentations that may be of interest to an event planning committee

1st _______________________________________

2nd _______________________________________

3rd _______________________________________

4th _______________________________________

5th _______________________________________

Circle all that apply to the following statements

1.

I would like to be included in the teacher IOLI Education Committee database

Yes

 

No

 

2.

I am interested in teaching at IOLI conventions only

 

Yes

 

No

3.

I am interested in teaching weekend workshops in other areas of the country

Yes

 

No

 

4.

I will accept students of mixed skill levels in a one class

 

Yes

 

No

5.

I prefer to teach the following skill levels. Indicate preferences with

# 1 — first choice, 2 — 2nd choice, 3 —3rd choice

Adv

Int

Beg

6.

Number of hours preferred for teaching at IOLI conventions

24

18

12

6

7.

Maximum number of students that I will accept in a class

12

10

8

Other =

I am a member of the following lace related organizations:

_______________________________ ______________________________

_______________________________ _______________________________

_______________________________ _______________________________

Other comments: