5th Annual International Conference on
Religion, Conflict, and Peace


 ~ Spring, 2013 ~  
Common Bond Institute


Dialogue Facilitator Form
(PLEASE TYPE OR PRINT CLEARLY. SUBMIT IN PLAIN TEXT FORMAT TO ALLOW FOR EDITING)
* See Posted Guidelines for Proposals on our website

1. Name & Credentials _________________________________________________
 
   Address ____________________________________________________________

                  _____________________________Country _________________________

    Phone day                                            Eve                                      Fax                        

    E-Mail:                                                    Web:                                                               

 2. Facilitator Style and Methods: Please describe your facilitation style and give examples of any particular tools or methods you utilize (use additional page in needed):

 


3. DESCRIPTION OF DIALOGUE GROUPS*: These are daily concurrent groups all participants take part in. As these can be large groups, individual or teams of 2 facilitators are possible. Individuals can be paired up in advance as wished. (*Please read description of Dialogue groups at: www.cbiworld.org/Pages/Conferences_RCP_ProgOverview.htm)

4. How many sessions are you available for and what days (min. of 2 required)? _________

5. PERSONAL/PROFESSIONAL BIOGRAPHICAL STATEMENT (for printed program – max. 70 words). Include credentials/degrees, occupation, and any position. Also include (separately) a current brief resume.
Co-facilitators:
If you have a co-facilitator please also include their name and information.

6. The TC Conference is a DIALOGUE PROCESS meant to build as a learning community over the 4 days of the program toward sharing skills and cooperation. As a result we request facilitators to be with us for all or as much of the conference as possible. Will you be participating throughout the conference? _________

7. 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.

8. 2 Professional References (names, position, relationship, & contact information – including Email address):

 

Submission

Please submit proposals by E-mail (preferred), fax, or land mail to:
   Common Bond Institute
Details at Website: www.cbiworld.org/Pages/Conferences_TC.htm
Attn: Steve Olweean, Director, Conference Co-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 Dialogue on our website at:
www.cbiworld.org/Pages/Conferences_RCP_Schedule-Overview12.htm
(*please submit proposal in plain text form to allows for easy editing)

(Facilitators receive a 50% discount off program fee)

Main TC Conference Page

Common Bond Institute
Steve Olweean, Director, SOlweean@aol.com
12170  S. Pine Ayr Drive •
Climax, Michigan49034 USA
1.269.665.9393 (phone and fax
)
Website: http://www.cbiworld.org
CONTACT US!