Wavelength - Annual Conference

Call now! Sally is waiting!	REGISTRATION IS NOW CLOSED!
	1.	Call Sally toll-free at 877-LAUGHS-2 or 773-784-1012 to register with a credit card or purchase order number*.
	2.	Complete the form below and send it to us via mail or fax. MAIL: Wavelength, Inc. 4753 N. Broadway, Ste 808 Chicago, IL 60640 FAX: (773) 784-1079

REGISTRATION INFORMATION – ONLY ONE REGISTRANT PER FORM*
Name (Mr./Ms./Mrs./Dr.)
Position title
First name on badge
Organization
Address
City
State
Zip
Office phone	Ext
Fax
Email

REGISTRATION fee
	Wednesday only (Nov. 07)
	Thursday only (Nov. 08)
	Full Conference
	Amount enclosed
PAYMENT METHOD
		Check payable to Wavelength (FEIN # 36-4099219)
		Purchase order enclosed
		Charge my MasterCard VISA
		Acct. No.
		Exp. Date (mm/yy)
		Name on card (print)
		Signature

* Multiple registrations may be included on one purchase order, however, each individual needs to submit a registration form.