REGISTRATION FORM 

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

41st Midwest Facilitators' Conference 
Monday, October 16, 2006

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 

41st Midwest Facilitators' Conference @ Chicago Indoor Racing
Buffalo Grove, Illinois (NW Chicago Suburb) - Monday, October 16, 2006 

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

_____________________________________	Full Conference Registration:				$ ___________ 
Name(s)									 (by 10/11: $110 - after 10/11: $125 - on site: $135) 

_____________________________________	Half-day Conference Registration:			$ ___________ 
Company									 (by 10/11: $75 - after 10/11: $80 - on site: $85)

_____________________________________		Full Day Mark Session Choices:   2: A - B         3: A - B      4: A - B
Address & Mail Code						Half-Day Mark Session Choices:  2: A - B   or   3: A - B      4: A - B

_____________________________________	___________-___________-___________-___________ 
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