REGISTRATION FORM

Midwest Facilitators' Network
(http://www.midwest-facilitators.net)
29th Midwest Facilitators' Conference
Friday, April 26, 2002

Email:		register@midwest-facilitators.net
 
Tel:            	(773) 463-2288

Fax:           	(773) 463-1830

Snail Mail:	Jordan-Webb
2656 West Montrose Ave  - Suite 110
Chicago, IL 60618

29th Midwest Facilitators' Conference @ Citi Commerce Solutions (Deerfield, Illinois) - April 26, 2002

_____________________________________	Discounted Early Registration Fee:$100/participant: $ ____________
Company									(if registration received on or before April 19,2002)

_____________________________________ 	Conference Registration Fee: $120/ participant: $ ____________
Name						Walk-in Registration Fee: (if registration received after April 19, 2002)

_____________________________________	Fort Survey Option: $25/registrant: 	$ _______________
Address & Mail Code									(Advance payment required)

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

_____________________________________		__________________________________	_____/_____
Business Phone			Business Fax		Signature						Card Exp Date

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