REGISTRATION FORM

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Midwest Facilitation Network
(http://www.midwest-facilitators.net)
35th Midwest Facilitation Conference
Friday, October 22, 2004

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

 

35th Midwest Facilitators' @ SBC Illinois
Downtown Chicago, Illinois - Friday, October 22, 2004



________________________________________
Name


Discounted Early Registration Fee: $99.00/participant:
   (if registration received on or before October 18, 2004)
$______
________________________________________
Company


Conference Registgration Fee: $119.00/participant:
(if registration received after October 18f, 2004)

$______
________________________________________
Address & Mail Code

Walk-In Registration Fee: $119.00/participant:

(if payment received at the door)
$______

________________________________________
City/State/Zip

_________-_________-_________-_________

Visa-MasterCard-American Express-Discover-Diner's Club
 
________________________________________
Business Telephone                              Business Fax
_______________________    _________   _______
Signature                                 Exp Date         VCODE


____________________________________
E-Mail Address                                      Website


___________________________________

Your Company Purchase Order # for Billing

Mark
Tandem Session Choices:    Session 2: A - B 

    /    Session 3: A - B   /   Session 4: A - B


(Location / Conference Agenda / Conference Information / Travel Suggestions / Lodging Suggestions)
(About the Presentations / MFN Contacts / Upcoming Events/Notices / Registration Information)
Top Conference Announcement  /  Back to MFN Home Page