Common Bond Institute
Annual International Conference on
"ENGAGING THE OTHER:" The Power of Compassion
May 4-5, 2013
Common Bond Institute ~ People's Peace Fund ~ Michigan State University ~ International Humanistic Psychology Assoc.
Presenter Proposal Form
for Breakout Session*
(PLEASE TYPE OR PRINT CLEARLY,
AND SUBMIT IN PLAIN TEXT FORMAT TO ALLOW FOR EASY EDITING)
* See Posted Guidelines for Proposals on our website
1. Name & Credentials ___________________________________________________
Phone day ( ) eve ( ) Fax ( )
2. Workshop/Presentation Title (for printed program -
max. 12 words):
3. Workshop/Presentation Brief Description (for printed
program - max. 45 words). Please be clear and direct about what you
are going to do:
4. Relevence To Conference Topic And Mission: Please
indicate how your presentation is relevant to the topic: "Engaging The
Other: The Power of Compassion," as well as how it advances public dialogue,
awareness, and sensitivity to these issues (use additional paper if needed):
5. Theme Category: Please indicate which theme(s) your
session most closely relates to (check all that apply):
[ ] Peace & Social Justice [ ] Religious & Cultural Harmony
[ ] Good Governance [ ] Psycho-Social Development & Identity
[ ] Economic Equity [ ] Environmental Sustainability [ ] Other
6. Session Format (Important
Note: The ETO Conference is a interactive,
dialogue oriented conference. All sessions are
requested to include substantial interaction and engage direct attendee participation
rather than primarily lecture). Check all that apply:
[ ] Skills [ ] Experiential [ ] Roundtable
[ ] Demonstration [ ] Discussion [ ] Lecture [ ] Multimedia
7. Personal/Professional Bio Statement (for printed
program - max. 75 words).
Please include credentials/degrees, occupation, and any position. Also include (separately) a current brief resume.
Co-presenters: If you have co-presenters please also include their name and information.
8. Continuing Education Credits: Will presentation be
structured to meet CEC requirements?:
[ ] Yes [ ] No
9. Any Equipment Needed (Equip. is limited):
10. PLEASE NOTE: The ETO Conference is an Interactive
meant to build as a learning community over the 4 days of the program toward
strategies and collaboration. As a result we strongly encourage all selected
presenters to be with us for all or most of the conference. Will you be participating
throughout the conference? ______
11. If you are a licensed practitioner, has your professional
license or insurance ever been on probation, suspended, or revoked?
[ ] Yes [ ] No If yes, please explain on a separate sheet.
12. TAPING: Conference sponsors periodically tape or
photograph presentations for professional use. Please
indicate if this is not agreeable (if not indicated it is assumed to be agreeable):
[ ] I Agree [ ] I do not Agree
13. A collection of ARTICLES submitted by conference
presenters relevant to their presentations is being generated for publication
in a virtual journal on our web site. Submissions in advance are requested.
Guidelines are provided on request. Would you wish to contribute such an article?
[ ] Yes [ ] No
14. ADDITIONAL REQUESTED INFORMATION (*please
submit proposal in plain text form to allows for easy editing):
[ ] Full Presentation Description: (approx. 200 words on separate sheet,
with description of qualifications and familiarity with the subject)
[ ] A Current Brief Resume for all presenters and co-presenters
[ ] 2 Professional References (names, position, relationship, & contact info.).
E-mail is preferred for references outside the US (f unavailable, fax number).
For references within the US include E-mail, phone, and fax.
[ ] When We Can Reach You (best days and times):
Please submit proposals by E-mail (preferred), fax, or land mail to:
Common Bond Institute
Details at Website: www.cbiworld.org/Pages/Conferences_ETO.htm
Attn: Steve Olweean, Director, Conference Coordinator
12170 S. Pine Ayr Drive, Climax, MI 49034 USA
Ph/Fax: 269-665-9393 Email: SOlweean@aol.com Website: www.cbiworld.org
(This form can be copied & pasted into an Email to complete & submit)
* See Posted Guidelines for Proposals on our website at:
CBI ~ PPF ~ MSU ~ IHPA
(Presenters receive a 25% discount off program fee)