Registration Form - Step 1

Printable version of this form

Registration form for Thursday, June 14, 2012 Tutor/Mentor Leadership & Networking Conference. Registration is completed in three steps:

Step 1 - Registration: Complete and Submit the registration form separately for each person attending the conference.

Step 2 - Payment: Select and Pay for one or more registrations.

Step 3 - Confirmation: Check your email for your email confirmation letter.

If you have any questions during this process, please contact us at tutormentor2@earthlink.net.

Complete and submit the registration form separately for each person attending the conference.

Contact Information

*First Name:
*Last Name:
Title:
Program/Department:
Organization/Company:
Address:
City:
State:
Zip:
Phone:
Fax:
Website:
*Email:

*Your email address will be used to confirm your registration.  You will also be added to a mailing list for important Conference announcements and information. You can unsubscribe from this list at any time.  We will not share, sell, or spam your email address.

Online Attendee List

We maintain an online list of people attending our conference. This list is intended to help attendees connect with other attendees. With your permission, we will publicize your full name, organization, city and state only. People will be able to contact you via a form but your email address will not be revealed.

Yes, please add me to the online list of attendees for this conference.


This is a one-day conference.

Thursday, June 14 - $20; continental breakfast only

How will you pay for this registration?

Online via PayPal

By Mail (check) Use address below.

At the Door (cash or check only)

Payment & Mailing Address

Make checks payable and mail to: Tutor/Mentor Connection, Tutor/Mentor Institute, LLC., Merchandise Mart PO Box 3303, Chicago, Il. 60654.



Questions or Comments (Since the fee is $20, there will be no scholarship rate for this event.

When you click Send, your form will be sent immediately.