REGISTRATION FORM

Midwest Facilitators' Network
(http://www.midwest-facilitators.net)
31st Midwest Facilitators' Conference
Friday, January 10, 2003

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

31st Midwest Facilitators' Conference @ Summit Executive Centre
Downtown Chicago, Illinois - Friday, January 10,  2003

_____________________________________	Discounted Early Registration Fee:$100/participant: $ ____________
Company									(if registration received on or before January 6,2003)

_____________________________________ 	Conference Registration Fee: $120/ participant: $ ____________
Name						Walk-in Registration Fee: (if registration received after January 6, 2003)

_____________________________________	
Address & Mail Code

_____________________________________		___________-___________-___________-___________
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