Registration Form for November 7, 2014 Conference

Print and complete this form (PDF version) to register to attend the November 7, 2014 Tutor/Mentor Leadership and Networking Conference which will be held at Metcalfe Federal Building, 77 W. Jackson, 3rd Floor, 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, November 4, 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.