The NJ Police Chief Magazine Volume 23, Number 4 | Page 32

N EW J ERSEY S TATE A SSOCIATION OF C HIEFS OF
THREE DAY PROGRAM—SEE AGENDA FOR TIMES AND LOCATIONS.
FRIDAY, SEPTEMBER 22ND—SUNDAY, SEPTEMBER 24TH
FEE: $750.00
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PLEASE DUPLICATE THIS FORM FOR EACH REGISTRANT.
REGISTRATIONS MUST BE PAID IN ADVANCE BY CHECK OR PURCHASE ORDER.
YOU WILL RECEIVE AN E-MAIL CONFIRMATION WITH HOTEL INFORMATION PRIOR
TO THE EVENT.
CANCELLATIONS MUST BE RECEIVED 14 BUSINESS DAYS PRIOR TO THE COURSE
IN ORDER TO BE ISSUED A REFUND.
THE SEMINAR MAY BE CANCELED DUE TO INSUFFICIENT ENROLLMENT.
NJSACOP OFFICE USE ONLY
RETURN THIS FORM TO:
NJSACOP
751 ROUTE 73 NORTH, SUITE 12
MARLTON, NJ 08053
FAX #: [phone]
DATE RECEIVED _____________
CONFIRMATION FAXED OR E-MAILED ______________
PAYMENT RECEIVED ______________
NAME:
TITLE/RANK/POSITION:
AGENCY/DEPARTMENT:
ADDRESS:
CITY/STATE/ZIP:
TELEPHONE:
FAX:
E-MAIL ADDRESS:
(confirmations will be sent via e-mail)
METHOD OF PAYMENT:
 CHECK ENCLOSED
 PURCHASE ORDER
CREDIT CARD: ___ VISA ____ MASTERCARD ___ AMEX
CREDIT CARD #: ___________________________________________________________________
EXPIRATION DATE: ___________________________________ CVV CODE: ___________________
BILLING ADDRESS: _________________________________________________________________
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SIGNATURE
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DATE
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