Common Bond Institute    
www.cbiworld.org

4th Annual International Conference on
"Engaging The Other:" The Power of Compassion

November 12-15, 2009 ~ San Francisco (San Mateo), Calif. USA

Common Bond Institute ~ National Coalition for Dialogue and Deliberation ~ International Humanistic Psychology Assoc.

Dialogue Facilitator Form*
(PLEASE TYPE OR PRINT CLEARLY, AND ALLOW FOR EDITING WITH ANY FORMATTING
* See Posted Guidelines for Facilitating on our website)

1. NAME & Credentials                                                                                                                          

   Address                                                                                                                                        

   Phone day (    )                                 eve (    )                                  Fax (    )                                

   E-Mail                                                                    Web:                                                              

2. FACILITATION 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 concurrent groups all participants take part in,
    75-90 min. in length, and occur once or twice a day, for a total of 4 or 5 dialogue periods in the full 3 ½ day
    schedule. As these are large group discussions, teams of 2 facilitators are preferred. Individuals can be
    paired up in advance as wished. (* Please read full description of Dialogue groups on our website at:
    www.cbiworld.org/Pages/Conferences_ETO_ProgOverview.htm

4. THEME CATEGORY: Please indicate dialogue group theme(s) you are most interested in (check all that apply):
    [  ] Peace & Social Justice  [  ] Religious & Cultural Harmony  [  ] Psycho-Social Development & Identity
    [  ] Good Governance         [  ] Environmental Sustainability    [  ] Economic Equity

5. HOW MANY SESSIONS are you available for and WHAT DAYS (min. of 2 sessions required)?                  

6. PERSONAL STATEMENT / PROFESSIONAL BIOGRAPHY (for printed program - max. 75 words).  
     If you have a co-facilitator include their information. Include credentials/degrees and occupation.
    *Please also include a current brief resume and/or curriculum vita for all facilitators and co-facilitators:

7. The ETO Conference is a DIALOGUE PROCESS meant to build as a learning community over the 3 ½ days
     of the program toward strategies and collaboration. As a result we strongly encourage facilitators to be with
     us for all or most of the conference. Will you be participating throughout the conference?              

8. 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.

9. 2 Professional References (names, position, relationship, & contact information - including Email address).
    When Can We Reach You (best days and times):                                                                                  

C B I         I H P A

SUBMISSION: *
This form can be copied and pasted into an Email to complete and submit to:

 Common Bond Institute
                        Attn: Steve Olweean, Director
                  12170 S. Pine Ayr Drive, Climax, MI 49034 USA  
                  Ph/Fax: 269-665-9393   Email: SOlweean@aol.com   Website: www.cbiworld.org

(A pdf version of the form is also available for fax or landmail submission at:
www.cbiworld.org/Pages/ETO_09_FacilitatorForm.pdf  
* See Posted Guidelines for Facilitating on our website at:
http://www.cbiworld.org/Pages/Conferences_ETO_ProgOverview.htm

(Facilitators receive a 50% discount off program fee)