REGISTRATION FORM - MIDWEST FACILITATORS' NETWORK
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http://www.midwest-facilitators.net

29th Midwest Facilitators' Conference
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Friday, April 26, 2002
Stuart School of Business (Downtown Chicago)

Email:    E-mailto: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


28th Midwest Facilitators' Conference
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Friday, April 26, 2002
Citi Commerce Solutions
Deerfield, IL 60015



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

Conference Registration Fee:       $120/participant: $ ____________
                                   (if registration received  
                                    after April 19, 2002)

Walk-In Registration Fee:          $120/participant: $ ____________
                                   (if payment received  
                                    at the door)

Forté Communications Survey Option:$25/participant   $ ____________
                                   for the survey
                                   (Advance Payment Required)

________________________________________________________
Name

________________________________________________________
Company							

________________________________________________________
Address & Mail Code

________________________________________________________
City/State/Zip

________________________________________________________
Business Phone                              Business Fax

________________________________________________________
E-Mail Address and Website Address

________________________________________________________
Your Company P O Number for Invoicing

___________-___________-___________-___________  ______/______
VISA / MASTERCARD Number                         Card Exp Date 

________________________________________________________
Signature