Common Bond Institute

7th 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 ___________________________________________________

    Address ______________________________________________________________

                  ______________________________________________________________

    Phone day (    )                                 eve (    )                             Fax (    )                           

    E-Mail:                                                       Web:                                                                

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 Dialogue Process 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):

Proposal Submission
Please submit proposals by E-mail (preferred), fax, or land mail to: