3rd Annual International
Conference on
"Engaging The Other"
The
Power of Compassion
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Presenter
Proposal Form
( PLEASE TYPE
OR PRINT CLEARLY)
1. Presenter & Credentials _______________________________________________________
Address ______________________________________________________________________
_______________________________________________________________________________
Phone day ( ___ ) ________________________ evening ( ___ ) _____________________________
Fax ( ___ ) _______________________ E-mail _______________________________________
Website _______________________________________________________________
2. Presentation/Workshop
Title (for printed program - maximum 12 words):
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
3. Presentation Brief Description
(for printed program - maximum 45 words).
Please be clear & direct about what you are going to
present:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
______________________________________________________________________________
_______________________________________________________________________________
4. Personal Statement/Professional
Biography (for printed program - max. 45 words).
Please include credentials/degrees and positions.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_________________________________________________________
Co-presenters: If you have co-presenters, please copy this form; each presenter will
need to complete personal information. A brief vita for each presenter should be included.
_________________________________________________________
5. Instructional
Format (All
sessions are encouraged to include interaction). Check all that
apply:
[ ] Experiential [ ] Movement
[ ] Demonstration
[ ] Multimedia
[ ] Discussion
[ ] Roundtable [ ] Lecture
6. Will this presentation be structured
to meet Continung Education Credits (CEC) requirements?:
[ ] Yes [ ] No
7. Any Equipment Needed: ____________________________________________________
8. Checklist of Requested Information
and References:
[ ] Title of Presentation
[ ] Brief Description of Presentation (use separate
sheet if necessary)
[ ] Personal Statement/Biographical (use separate
sheet if necessary)
[ ] Full Description of Presentation: (200 words or less
- on a separate sheet,
including a statement describing
your qualifications & familiarity with the subject)
[ ] A Current Brief Resume and/or curriculum vita for
all presenters and
co-presenters
[ ] Two Professional References (names, position, and
contact information). E-mail
addresses are preferred (or
if unavailable, fax numbers) for references outside
the US. For references within
the US include e-mail, phone, and fax.
[ ] When We Can Reach You (best days & times):________________________
9. 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.
10. Taping: Conference sponsors
request the right to tape conference presentations for professional use.
[ ] I Agree to let my Presentation be Taped
or Photographed.
________________________________
_____________________
Signature
Date
11. A collection of Articles submitted
by conference presenters relevant to their presentations at this conference
is being generated for
publication in a virtual journal on our web site. Would you wish to
contribute such an article?
[ ] Yes [ ] No
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Proposal Submission
Please submit proposals by E-mail (preferred), fax, or land mail to:
Common Bond Institute using the contact information listed below.
SUBMISSIONS REQUESTED BY: March 15, 2008
( Early submission is recommended as we expect the program to fill up early )
2008 ETO Conference Information
Main ETO Conference PagePrevious 2007 ETO Information:
Previous 2007 ETO Program Sessions
Previois 2007 list of PresentersPrevious 2006 ETO Information:
Previous 2006 ETO Program Sessions
Previois 2006 list of Presenters
Common
Bond Institute
Steve Olweean, Director,
SOlweean@aol.com
12170 S. Pine Ayr Drive
Climax, Michigan
49034
USA
1.269.665.9393 (phone and fax)
Website:
http://www.cbiworld.org
CONTACT
US!
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