6th Annual International Conference on
Transgenerational Trauma:
Communal Wounds and Victim Identities

October 12-14, 2017~ Amman, Jordan

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

Presenter Proposal Form
for Breakout Session

This form can be copied & pasted into an Email to complete & submit

(PLEASE TYPE OR PRINT CLEARLY, AND SUBMIT IN PLAIN TEXT FORMAT TO ALLOW FOR EASY EDITING)  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 – max. 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 Conference Topic And Mission: Please indicate how your presentation is relevant to the topic: “Transgenerational Trauma: Unresolved Communal Wounds and Victim Identities” as well as how it advances understanding, treatment, prevention, and public dialogue and awareness of this issue (use additional paper if needed):

5. Theme Category: Please indicate which theme(s) your session most closely relates to (check all that apply):
[ ] Psycho-Social [ ] Humanitarian Response [ ] Neurological [ ] Educational
[ ] Peace Activism & Studies [ ] Cultural & Religious [ ] Historical/Anthropological
[ ] Migration, Resettlement, & Integration [ ] Global Relations [ ] Public Policy & Law
[ ] Other ____________

6. Session Format (Important Note: The TT Conference is an interactive, dialogue oriented conference to promote the most shared learning. All presenters are asked to include interaction and direct attendee participation where possible). Check all that apply:
[ ] Skills [ ] Demonstration [ ] Roundtable/Panel [ ] Discussion/Dialogue
[ ] Experiential [ ] Lecture/Research [ ] Multimedia

7. Personal/Professional Bio Statement (for printed program – max. 75 words).
Please include credentials/degrees, occupation, and any position. Also include (separately) a current brief resume. *We prefer not to edit longer personal bios, so appreciate keeping within the word limit.
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: _____________________________________

10. PLEASE NOTE: The TT Conference is an Interactive Dialogue Process meant to build as a learning community over the 4 days of the program toward outcomes and collaboration. As a result we ask all selected presenters to be with us for all or most of the conference. This is an important factor in selection. (Presenters receive a 20% Discount off the Program Fee)
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. ADDITIONAL REQUESTED INFORMATION (*please submit proposal in plain text form to allows for easy editing):
[ ] Full Presentation Description: (approx. 200 – 300 words on separate sheet, with
description of qualifications and familiarity with the subject)
[ ] A Current Brief Resume for all presenters and co-presenters
[ ] 2 Professional References (names, position, relationship, & contact info.).
Please include E-mail, as well as phone/fax and mailing address.
[ ] When We Can Reach You (best days and times)

15. Common Bond Institute promotes and supports the cross-cultural study of Transgenerational Trauma through a Global Network of professional study groups.
Are you associated with an existing professional Study Group that addresses this issue?
[ ] Yes [ ] No
If so, what group and country (organization, professional group, etc.):
___________________________________
If not, are you interested in forming or joining a study group? [ ] Yes [ ] No


Submission Date By: August 15, 2017
NOTE: Early submission is highly recommended
to ensure consideration for the limited number of session openings

Please submit proposals – in plain text and with no imbedded formatting – by E-mail to:

Common Bond Institute
Attn: Steve Olweean, Director, Conference Coordinator
12170 S. Pine Ayr Drive, Climax, MI 49034 USA
Ph/Fax: 1-269-665-9393  Email: SOlweean@aol.com
Details at Website:  www.cbiworld.org
(* This form can be copied & pasted into an Email to complete & submit by Email. If Email is not possible you may submit by land mail or fax)

See Posted Guidelines for Proposals

(Presenters receive a 20% Discount off the Program Fee)