Return this form to : NJSACOP 751 Route 73 North , Suite 12 , Marlton , NJ 08053 Fax # 856.334.8947 E-mail : registrations @ njsacop . org
· You will receive an email confirmation
· Cancellations must be received by March 2nd to receive a refund or credit
F�� : $ 600
Chief ’ s Name / Date of Appointment
____________________________________________________________________________________ Agency / Department
____________________________________________________________________________________ Address
____________________________________________________________________________________ City / State / Zip
____________________________________________________________________________________ E-mail
____________________________________________________________________________________
Superior Officers will also be attending for an additional $ 400 [ per additional attendee ]
Name [ s ]: ____________________________________________________________________________
E-mail [ s ]: ___________________________________________________________________________
TOTAL : ________________
METHOD OF PAYMENT : Check Enclosed Purchase Order
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