REGISTRATION FORM 

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

38th Midwest Facilitators' Conference 
Monday, October 31, 2005

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 

38th Midwest Facilitators' Conference @ Hamburger University
Oak Brook, Illinois - Monday, October 31, 2005 

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

_____________________________________	Full Conference Registration:				$ ___________ 
Name(s)									 (by 10/24: $110 - after 10/24: $125 - on site: $135) 

_____________________________________	Half-day Conference Registration:			$ ___________ 
Company									 (by 10/24: $75 - after 10/24: $80 - on site: $85)

_____________________________________	
Address & Mail Code					Half-day (lunch included) indicate sessions: 1-2 / 3-4 / 2-3

_____________________________________	___________-___________-___________-___________ 
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