New Jersey State Association of Chiefs of Police 105 th Annual Training Conference June 26 – June 29 , 2017 Resorts Casino Hotel & The Atlantic City Convention Center REGISTRATION FORM
Attendee Information :
Title & Name ___________________________________________________________________________________________________ Agency ________________________________________________________________________________________________________ Address _______________________________________________________________________________________________________ City , State , Zip __________________________________________________________________________________________________ Email ( required for Confirmation )_____________________________________________________________________________________ County __________________________________
Spouse / Companion Information - shared for spouse events at convention If attending ALL events – see below for list of events :
Name ________________________________ Email _____________________________________________ Phone __________________
ADDITIONAL Banquet tickets : $ 125 per ticket Quantity ________
Full registration fees include Banquet ticket ; do not order if you register in full below .
Child ( ren ) ( if under 18 , no fees apply ): Name ( s )_______________________________________________________________________________________________________
Member Status / Fees : Active [ ] $ 345 L . E . Associate [ ] $ 345 P . S . Affiliate [ ] $ 345 Non-Member [ ] $ 365 Retired [ ] $ 185 Late fee [ ] $ 25 if registering after 6 / 21 / 17 Fees include : Host Chiefs Night , Tuesday & Wednesday Breakfasts / Seminars , Installation Banquet
Spouse Status / Fees : Active , L . E . Assoc ., P . S . Affiliate , Non-Member [ |
] $ 195 |
Retired [ |
] $ 140 |
Fees include : Host Chiefs Night , Tuesday & Wednesday Breakfasts / Seminars , Special Spouse Event ( s ), Installation Banquet |
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Fee Totals : |
Attendee fee - |
$____________ |
Spouse fee -
$____________ Banquet ticket ( s ) - $____________ Late fee - $____________ TOTAL AMOUNT DUE - $____________
Make Purchase Orders / Checks payable to : New Jersey State Association of Chiefs of Police
Return completed registration form along with payment information to : NJSACOP - 751 Route 73 North , Suite 12 - Marlton NJ 08053 Tel - 856 / 334-8943 Fax - 856 / 334-8947
Credit card info - CC #__________________________________________________________ Expiration date _______ /________ 3 or 4 digit CVV ___________ Amount to be charged - $________________ Signature ____________________________________________________________________ Address of CC holder _______________________________________________________________________________________________
Hotel room reservations can be made here : https :// meetatresortsac . com / vnjc17 OR CALL DIRECT : 888-797-7700 & USE CODE VNJC17
Please use the Breakfast / Seminar Registration Form to add additional personnel for Tuesday & Wednesday .
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