REGISTRATION FORM


2013 MIDWEST REGIONAL ESOP CONFERENCE REGISTRATION

Thursday, September 12, 2013 - Friday, September 13, 2013

Navigating Into Your Future

Hilton Milwaukee City Center Hotel, 509 W. Wisconsin Avenue, Milwaukee, WI 53203

Members must login to the website to receive the member price.
  On/Before August 22  August 23 – September 5
Members:  $250.00 (1st registrant)
$250.00 (2nd registrant)
$200.00 (3rd or more registrants)
$300.00 (1st registrant)
$300.00 (2nd registrant)
$250.00 (3rd or more registrants)
     
Non Members:  $350.00 (1st registrant)
$350.00 (2nd registrant)
$350.00 (3rd or more registrants)
$450.00 (1st registrant)
$450.00 (2nd registrant)
$450.00 (3rd or more registrants)
     
After September 5:   $500  
*Please Indicate Number of Persons for Each Registration Category.

Members:
Non Members:

Total number of Registrants : Total:

Registrant 1

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First Name: Last Name:
Title: Email:

Registrant 2

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Registrant 3

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Registrant 4

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Registrant 5

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Registrant 6

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Registrant 7

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Registrant 8

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Registrant 9

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Registrant 10

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Company Information

Company Name:
Company Contact First Name:
Company Contact Last Name:
Address:
Address Line 2:
City:
State:
Zip:
Phone:
Country :
Fax:
Email:

Order Total:

* Name On Credit Card:  
Credit Card:
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* Security Code:

Expiration Date:


Your credit card will be charged the amount of : .



* Required Field
‡ The maximum amount of registants per request is 10.

Please only click on the submit registration button ONCE or your credit card will be charged multiple times.

After September 5: $500

Cancellation Policy: Cancellations must be received in writing, via fax or email, no later than September 1, 2014 to receive a refund. You may send a substitute. “No-Shows” will be invoiced the total registration fee.

Chicago Oak Brook Hills Hotel Room Reservation Information

Special Conference Room Rate: $149 (double) ● Phone: 855-458-5701● Group CODE: ESOP
OR  select the following link to book online: ESOP Reginal Conference

 

ROOM RESERVATIONS MUST BE MADE BEFORE AUGUST 20, 2014 TO RECEIVE GROUP RATE. The conference and the hotel room block have sold out every year, so be sure to book early.