REGISTRATION FORM 

Midwest Facilitators' Network 
(http://www.midwest-facilitators.net) 

32nd Midwest Facilitators' Conference 
Monday, October 20, 2003

Send to Registrar:    E-Mail:        register@midwest-facilitators.net 
                               Tel:            (773) 463-2288 
                               Fax:           (773) 463-1830 
                               Snail Mail:   MFN c/o Jordan-Webb 
                                                    2656 West Montrose Ave  - Suite 110 
                                                    Chicago, IL 60618 

32nd Midwest Facilitators' @ Loyola University Chicago - Water Tower Campus 
Downtown Chicago, Illinois - Monday, October 20, 2003 

_____________________________________	Discounted Early Registration Fee: $99.00/participant:	$ ___________ 
Name(s)									 (if registration received on or before October 14, 2003) 

_____________________________________	Conference Registration Fee: $119.00/participant:	$ ___________ 
Company									 (if registration received after October 14, 2003) 

_____________________________________	Walk-In Registration Fee: $119.00/participant:		$ ___________ 
Address & Mail Code								 (if payment received at the door) 

_____________________________________	___________-___________-___________-___________ 
City/State/Zip					VISA / MASTERCARD Number 

_____________________________________	__________________________________	___/___	______
Business Phone			Business Fax	Signature						Card Exp Date	VCODE 

_____________________________________	_____________________________________________ 
E-Mail Address and Website Address				Your Company P O Number for Invoicing 

Mark Tandem Session Choices:	Session 2: A - B	Session 3: A - B	Session 4: A - B