The NJ Police Chief Magazine Volume 26, Number 3 | Page 17

2019 NJSACOP MID-YEAR MEETING
ATTENDEE REGISTRATION FORM
ATTENDEE INFORMATION
Attendee Name
_____________________________________________________Rank: __________________________________
Department: ____________________________________________________________________________________
Address: _______________________________________________________________________________________
Telephone: _______________________________________ E-mail ________________________________________
REGISTRATION FEE:
$205.00
(Includes: breakfast, lunch, coffee
breaks, presentations and
entrance to vendor show)
PAYMENT INFORMATION
Payment Method:
____ CHECK ____ Purchase Order
(Made payable to NJSACOP, 751 Route 73 North, Suite 12, Marlton, NJ 08053)
CREDIT CARD: ____ Visa ____ MC ____ AMEX
Credit Card Number: _________________________________________________________________
Exp. Date: ____________________________ CVV (3 or 4 digit code): ___________________________
Signature: ________________________________________________________________________
Billing Address (if different from above):
________________________________________________________________________________
________________________________________________________________________________
RETURN COMPLETED FORMS TO:
NJSACOP ● 751 Route 73 North ● Suite 12 ● Marlton, NJ 08053
Phone: [phone] ● Fax: [phone]
Web: www.njsacop.org
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