Registration Form - October 20, 2003 - 32nd Midwest Facilitators Conference

REGISTRATION FORM

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Midwest Facilitation Network
(http://www.midwest-facilitators.net)
32nd Midwest Facilitation Conference
Monday, October 20, 2003

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

32nd Midwest Facilitators' @ Loyola University Chicago - Water Tower Campus
Downtown Chicago, Illinois - Monday, October 20, 2003

_____________________________________ Discounted Early Registration Fee: $99.00/participant: $ ____________
^{Name

(if registration received on or before October 14, 2003)}

_____________________________________ Conference Registgration Fee: $119.00/participant: $ ____________
^{Company
(if registration received after October 14, 2003)}

_____________________________________ Walk-In Registration Fee: $119.00/participant: $ ____________
Address & Mail Code (if payment received at the door)

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

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

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

Mark Tandem Session Choices: Session 2: A - B / Session 3: A - B / Session 4: A - B