Exhibitors Pay by Check

To Pay By Check
Print this form, fill out and mail with check

Name_______________________________________________

Address_____________________________________________

City _____________________________ St. ____Zip________

Phone______________________________________________

Email______________________________________________

Electricity Yes___ No ___

Product ______________________________________________

Make checks payable to: Mid-America Hypnosis Conference
PO Box 2731, Northlake, IL 60164

Fax Number: 847-455-0890 E-Mail: mrcarm@aol.com : 847-451-9303