REGISTRATION FORM 

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

34th Midwest Facilitators' Conference 
Friday, May 7, 2004

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 

34th Midwest Facilitators' @ Catalyst Ranch
Downtown Chicago, Illinois - Friday, May 7, 2004 

Now accepting all major credit cards: (Visa, Mastercard, American Express, Discover/Novus, Diner's Club)

_____________________________________	Discounted Early Registration Fee: $99.00/participant:	$ ___________ 
Name(s)									 (if registration received on or before 04/30/2004) 

_____________________________________	Conference Registration Fee: $119.00/participant:	$ ___________ 
Company									 (if registration received after 04/30/2004) 

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

_____________________________________	___________-___________-___________-___________ 
City/State/Zip					CREDIT CARD 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