RegistrationMaterials

3RD ANNUAL ILLINOIS FOOD SUMMIT CONFERENCE

BRINGING CHANGE TO THE TABLE

 INDIAN LAKES RESORT CENTER

  BLOOMINGDALE, ILLINOIS

   NOVEMBER 7 – 9, 2003

Please print this form, fill out and return by fax.

GENERAL INFORMATION:

LAST NAME:

FIRST NAME:

ORGANIZATION:

POSITION /TITLE:

ADDRESS:

NAME TAG PREFERENCE:

PHONE:

FAX:

EMAIL:

FIRST TIME ATTENDEE OF ILLINOIS FOOD SUMMIT CONFERENCE: YES / NO

Emergency Contact:

Name:

Daytime Phone:

Relationship: Evening Phone:

Lodging at Indian Lakes Resort Center:

I need lodging at Indian Lakes: Yes / No

I need transportation: Yes/No?

Arrival Date: Departure Date:

Smoking or Nonsmoking room: Single or Double:

I want to share a room with: ____________________________________________________

(Rooms are based on double occupancy. Singles are available at an additional cost)'''

Special request / restrictions / dietary needs:_______________________________________

Number of children needing childcare: ____ We follow up with you. (Kid’s Club welcomes children from 3-12 years-old. All toddlers must be potty trained.)

Registration deadline is October 15, 2003.

Conferance organizers will confirm registration, transportation and childcare arrangements by email or by phone. Any questions, please contact LaVida? Davis, ICRD Project Manager at 708-602-9098. Please return all registration forms to BY FAX OR EMAIL:

ICRD 4436 West Maypole Chicago, IL 60624 Fax: 773-261-3189 Email: lavida.davis@comcast.net

mailto:lavida.davis@comcast.net or songobisi@netzero.net for questions about the invitation list