The NJ Police Chief Magazine Volume 23, Number 6

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 Non-Member [ ] $365 L.E. Associate [ ] $345 Retired [ ] $185 P.S. Affiliate [ ] Late fee [ ] Fees include: Host Chiefs Night, Tuesday & Wednesday Breakfasts/Seminars, Installation Banquet $345 $25 if registering after 6/21/17 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 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Attendee fee - $____________ Fee Totals: 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. 20

The NJ Police Chief Magazine Volume 23, Number 6 | Page 21