Return this form to: NJSACOP 751 Route 73 North, Suite 12, Marlton, NJ 08053 registrations @ njsacop. org
NJSACOP Office Use Only Date Received _____ Confirmation sent _____ Payment Received _____
Fee: $ 650.
• You will receive an email confirmation
• Cancellations must be received by April 3rd to receive a refund or credit
Chief’ s Name / Date of Appointment
____________________________________________________________________________________ Agency / Department
____________________________________________________________________________________ Address
____________________________________________________________________________________ City / State / Zip
____________________________________________________________________________________ E-Mail
____________________________________________________________________________________
Additional attendee( s) will also be attending for an additional $ 550 [ each additional attendee fee ]
Rank & Name: ______________________________________________________________________
Email: _____________________________________________________________________________
TOTAL: ________________
METHOD OF PAYMENT: Check Enclosed Purchase Order 11