Registration Form - January 24, 2005 - 37th Midwest Facilitators Conference

REGISTRATION FORM

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

Midwest Facilitation Network
(http://www.midwest-facilitators.net)
37th Midwest Facilitation Conference
Monday, May 23, 2005

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

37th Midwest Facilitation Conference @ De Paul Center
Downtown Chicago, Illinois - Monday, May 23, 2005

________________________________________
^Name

Early Registration Discount (by 05/18)
Full Conference: $110 - Half Day $75

$______

________________________________________
^Company

^{Late
Conference Registration (after 05/18)

Full Conference: $125 - Half Day $80}

$______

________________________________________
^{Address & Mail Code}

On-Site Conference Registration (05/23)
Full Conference: $135 - Half Day $85

$______

________________________________________
^{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 Session 4 Choices:    4A - 4B

Half-day (lunch included) indicate sessions: 1-2 / 3-4 / 2-3

________________________________________ ^Name	Early Registration Discount (by 05/18) Full Conference: $110 - Half Day $75	$______
________________________________________ ^Company	^{Late Conference Registration (after 05/18) Full Conference: $125 - Half Day $80}	$______
________________________________________ ^{Address & Mail Code}	On-Site Conference Registration (05/23) Full Conference: $135 - Half Day $85	$______
________________________________________ ^{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 Session 4 Choices: 4A - 4B	Half-day (lunch included) indicate sessions: 1-2 / 3-4 / 2-3