Registration Form - November 4, 2011 conference at the Metcalfe Federal Building, 77 W. Jackson Blvd., Chicago, Il.

Register Online

Registration is completed in three steps:

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

Step 2 - Payment: Pay for one or more registrations. (Send by mail or pay at the door.  See mailing address below.)

Step 3 - Confirmation: Check your email for your email confirmation letter.  If you do not receive an email within two weeks of your registration, please contact us.

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

Please print, complete and mail/fax one registration form for each person attending the conference.

Contact Information

First Name*:__________________  Last Name*: _____________________

Title:_______________________________________________________

Program/Department: _________________________________________

Organization/Company:________________________________________

Address:____________________________________________________

City:_____________________  State:________  Zip:________________

Phone:_______________________

Fax:_________________________

Website:__________________________________________

E-mail*:___________________________________________

*Your email address will be used to confirm your registration.  You will also be added to a mailing list for important May 2012 Conference announcements and information. You can unsubscribe from this list at any time.  We will not share, sell, or spam your email address.

Lunch Options

__ Please check this box to request a vegetarian lunch.


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.


Fees for Conference:

__ $80 in advance/$100 at the door

__ Scholarship requested - $20 fee


__ Contact Tutor/Mentor Institute at tutormentor2@earthlink.net to discuss group rates



How will you pay for this registration?

__ Online via PayPal

__ By Mail (check)

__ At the Door (cash or check only)


Questions or Comments:
If requesting $20 scholarship write that you accept $20 scholarship rate and include check. This is automatically approved.





Please mail/fax your completed registration form, along with your payment, to:

Tutor/Mentor Institute
c/o Merchandise Mart PO Box 3303, Chicago, Il. 60654

Make checks payable to Tutor/Mentor Connection, Tutor/Mentor Institute.

Please Note: With advance written notice (fax or email), we will refund the registration fee, less an administrative cost of $20 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 November 1, 2011 will be confirmed via fax or email.

NOTE: As of 7/1/2011 Tutor/Mentor Connection is being restructured and is no longer a 501-c-3. Conference fees will not be tax exempt. The Tutor/Mentor Institute, LLC has been created to support this effort.