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.

Presenter Proposal Form*
(PLEASE TYPE OR PRINT CLEARLY, AND ALLOW FOR EDITING WITH ANY FORMATTING
* 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 - maximum 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. RELEVANCE TO THE ETO 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 [  ] Psycho-Social Development & Identity
    [  ] Good Governance        [  ] Environmental Sustainability   [  ] Economic Equity    [  ] Other

6. SESSION FORMAT (NOTE: The ETO Conference is a dialogue & workshop oriented conference.
    All sessions are encouraged to be interactive and engage direct attendee participation). Check all that apply:
    [  ] Experiential   [  ] Movement   [  ] Demonstration   [  ] Discussion
    [  ] Roundtable   [  ] Lecture       [  ] Multimedia

7. PERSONAL STATEMENT / PROFESSIONAL BIOGRAPHY (for printed program - max. 75 words).
     Please include credentials/degrees, occupation, any position or key publications:

          CO-PRESENTERS: If you have co-presenters, please copy this form to include complete personal
          and professional information and references. A brief vita for each presenter should be included.

8. CONTINUING EDUCATION CREDITS: Will presentation be meet CEC requirements?: [  ] Yes  [  ] No

9. ANY EQUIPMENT NEEDED (Equip. is limited):                                                                    

10. 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 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. CHECKLIST OF REQUESTED INFORMATION (*please submit proposal in a form that allows for editing):
    [ ] Title
     [ ] Brief Description (use separate sheet if necessary)
     [ ] Personal Statement/Biographical (use separate sheet if necessary)
     [ ] Full Presentation Description: (approx. 200 words on separate page, with qualifications and familiarity with the subject)
     [ ] A Current Brief Resume and/or curriculum vita for all presenters and co-presenters
     [ ] 2 Professional References (names, position, relationship, & contact info.). E-mail is preferred (or if unavailable, fax numbers)
          for references outside US. Within US include e-mail, phone, & fax
     [ ] When We Can Reach You (best days and times):

PROPOSAL SUBMISSION: *
Submissions Requested By: July 1, 2009
( Early submission is recommended as we expect the program to fill up early )
C B I         I H P A
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_ProposalForm.pdf  
* See Posted Guidelines for Proposals on our website at:
http://www.cbiworld.org/Pages/Conferences_ETO_ProgOverview.htm

(Presenters receive a 50% discount off program fee)