June 20-23, 2012 ~ Amman, JordanCommon Bond Institute (US), International Humanistic Psychology Association,
for Breakout Session
OR PRINT CLEARLY. SUBMIT IN PLAIN TEXT FORMAT TO ALLOW FOR EDITING)
* See Posted Guidelines for Proposals on our website
1. Name & Credentials ________________+________________________________
Phone day Eve Fax
Title (for printed program - maximum 12 words):
3. Workshop/Presentation Brief Description
(for printed program - maximum 45 words)*
Please be clear & direct about what you are going to do:
4. RELEVANCE to the TC Conference topic and mission: Please indicate how your presentation is relevant to the topic: "Transforming Conflict: Sharing Tools For Dialogue and Engagement":
5. THEME CATEGORY: Please indicate which theme(s) your
session most closely relates to (check all that apply):
[ ] Communication [ ] Dialogue [ ] Teamwork [ ] Leadership [ ] Decision Making [ ] Negotiation
[ ] Problem Solving [ ] Mediation [ ] Conflict Resolution [ ] Other _________________
6. Session Format *
Note: The RCP Conference is an dialogue and skills training
oriented conference. All sessions are asked to be interactive and
engage attendee participation. Lectures only are discouraged.
Check all that apply:
[ ] Skills [ ] Experiential [ ] Demonstration [ ] Discussion
[ ] Roundtable [ ] Lecture [ ] Multimedia
7. Personal/Professional Biographical
Statement (for printed program - max. 70 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 (equipment is limited): __________________________________
10. PLEASE NOTE: 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 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. Guidelines are provided on request.
Would you wish to contribute such an article? [ ] Yes [ ] No
14. ADDITIONAL REQUESTED INFORMATION:
[ ] Full Presentation Description: (approx. 200 words on separate sheet,
with description of qualifications)
[ ] 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 Can We Reach You (best days and times):
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 Facebook: tinyurl.com/CBIonFB
(Copy & paste form into an Email to complete & submit).
*Submit proposal in plain text - i.e. not locked formatting - to allow for easy editing
* See Posted Session Guidelines on our website at:
Advanced submission recommended as program space is limited
(Presenters receive a 20% discount off the program fee)