New Jersey State Association of Chiefs of Police
FRIDAY , SEPTEMBER 16TH — SUNDAY , SEPTEMBER 18TH 2022 FEE : $ 675.00
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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 .
RETURN THIS FORM TO : NJSACOP 751 ROUTE 73 NORTH , SUITE 12 MARLTON , NJ 08053 EMAIL : REGISTRATIONS @ NJSACOP . ORG
NJSACOP OFFICE USE ONLY DATE RECEIVED _____________
CONFIRMATION FAXED OR E-MAILED ______________ PAYMENT RECEIVED ______________
PAYMENT : Form of Payment : Check ___ Purchase Order ___ Credit Card : __ Visa __ Mastercard __ AMEX
NAME :
TITLE / RANK / POSITION :
AGENCY / DEPARTMENT :
ADDRESS :
CITY / STATE / ZIP :
E-MAIL ADDRESS : ( confirmations will be sent via e-mail )
Credit Card #: _____________________________________ Exp . Date : ________ CC Code _______
Billing Address : ____________________________________________________________________________
City / State / Zip : _______________________________________________________________________
________________________________________ Signature
____________________ Date
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