NEW JERSEY STATE ASSOCIATION OF CHIEFS OF POLICE Police Executive Institute – 17 th Session
Monday, 16 April 2018— Friday, 20 April 2018 MAKE CHECKS / PURCHASE ORDERS PAYABLE TO AND SEND TO:
New Jersey State Association of Chiefs of Police 751 Route 73 North, Suite 12 Marlton, NJ 08053 P / 856-334-8943 F / 856-334-8947 E / njsacop @ njsacop. org
REGISTRATION FORM
Name:
______________________________________________________________________ Rank / Title: ______________________________________________________________________ Agency: Address: City:
______________________________________________________________________ ______________________________________________________________________ ___________________________________ State: _________ Zip: _____________ Phone / Fax / E-Mail: ________________________________________________________________ Form of Payment: Check ___ Purchase Order ___ Credit Card: __ Visa __ Mastercard __ AMEX Credit Card #: _____________________________________ Expiration Date: _________________ CC Security Code: _____________ Billing Address: ___________________________________________________________________ City / State / Zip: ____________________________________________________________________
******************************* � Deadline for Registration: April 01, 2018 [ space permitting ] � Registration Fee: $ 950 – Please make checks payable to NJSACOP
� The 2018 NJSACOP Police Executive Institute will be held at: The National Conference Center & Holiday Inn, 399 Monmouth Street, East Windsor, NJ
� Registrants will receive a confirmation prior to the course � Please duplicate this Registration Form for each registrant
� Registrations must be paid in advance by check or purchase order
� Cancellations must be received by March 15, 2018 in order to receive refund.
________________________________________ Signature
____________________ Date
17