Name: ___________________________________________ First time attendee? ___________

Address: _____________________________________________________________________

City: ___________________________________ State: __________      Zip: ________________

Home phone#: ____________ Work phone #: _____________ E-mail: ____________________

Institutional affiliation: ___________________________________________________________


Full meeting registration fees (includes Friday luncheon)                             Amount enclosed

Regular Member  (postmarked by 9/16/02): $75          $______________

Student Member     $35          $______________

Retiree       $35          $______________

Late registration (postmarked after 9/16/02):  $85          $______________

Day registration (10/18/02, includes luncheon)  $60          $______________

Indicate preference for business luncheon:  Meat _____  Vegetarian _____

Other dietary needs: ______________________________________________________


Return completed form with check payable to Midwest Chapter, MLA, to:

Robert C. Delvin, Fine Arts Librarian
The Ames Library
#1 Ames Plaza
P.O. Box 2899
Bloomington, IL 61702-2899

Cancellation Policy: Refund of the registration fee (minus $25.00 handling fee) will be given up until noon Thursday, October 17, 2002.