Registration Form for Tutor/Mentor Leadership & Networking Conference
The conference has not been held since May 2015 due to lack of fund. This is the registration form used. Print and complete this form (PDF version) to register to attend the next Tutor/Mentor Leadership and Networking Conference which will be held at (location TBD) in Chicago, Il.
Submit one form for each person that you are registering.
Name:_____________________________________________
Title:_____________________________________________
Organization:_____________________________________
Address:__________________________________________
City:_________________State:________Zip:__________
Phone:_______________________
Fax:_________________________
Website:__________________________________________
E-mail*:___________________________________________
*By providing your email address, you agree to be added to a mailing list for
important Conference announcements and information. You can unsubscribe
from this list at any time.
____ Please check to request a vegetarian lunch.
____ Please check to be added to the online attendee list which enables
other contact participants to contact you via a form on the Conference Web site.
Your email address is not shared through this process.
Registration fees
Registration Fees:
____ Monday, tbd, Single day conference registration - $80
____ Group Rate, $50 per person for groups of 3 or more (contact Dan Bassill
if you need a lower group rate, or a 50% discount half day rate.)
____ Scholarship Rate, $30 per person
Walk-In
Registration Fees (Register the day of the Conference):
Single day registration - $80 (check
or cash only)
Scholarships and group discounts are available. Please
contact us
for scholarships or group rate information.
How will you pay for this registration?
__ Online via PayPal (click here for
PayPal)
__ By Mail (check)
__ At the Door (cash or check only)
Please make checks payable to Tutor/Mentor
Institute, LLC
and mail payment to Daniel Bassill at
Tutor/Mentor Connection
Tutor/Mentor Institute, LLC
Merchandise Mart, PO Box 3303
Chicago, IL 60654
Fax 312-787-7713
Please Note: With advance written notice (fax or email), we will
refund the registration fee, less an administrative cost of $30 per day
registered. There will be NO refunds for "no shows" on the day of the Conference
and you will be responsible for the full registration fee.
Thank you for your registration. Registrations received by one week prior to the
Conference will be
confirmed via fax or email.
Tutor/Mentor Institute, LLC is not a 501 (c) (3) tax-exempt non-profit.
