Common Bond Institute

2nd Annual International Conference on
Transgenerational Trauma:
Communal Wounds and Victim Identities
June 20-22 , 2013 ~ Amman, Jordan

Common Bond Institute
International Humanistic Psychology Association, International Federation of Medical Students' Associations

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: http://www.cbiworld.org/Pages/Conferences_TT_Schedule-Overview.htm)

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

5. Do you have a working knowledge of both English & Arabic? [ ] Yes [ ] No
If only 1, which? [ ] English [ ] Arabic

6. 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.

7. The TT Conference is a DIALOGUE PROCESS meant to build as a learning community over the 4 days of the program. As a result we request facilitators to be with us for all or most of the conference (presenters and dialogue facilitators receive a 20% Discount off the Program Fee). 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):

Submission
(Facilitators receive a 20% discount off the Conference Program fee)
Please submit proposals by E-mail (preferred), fax, or land mail to:
   Common Bond Institute
Details at Website: www.cbiworld.org/Pages/Conferences_TT.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
(This form can be copied & pasted into an Email to complete & submit).
*Please submit proposal in plain text (i.e. not locked formatting) to allow for easy editing
See Posted Guidelines for Sessions on our website at:
www.cbiworld.org/Pages/Conferences_TT_Schedule-Overview.htm

Main TT Conference Page