2017 NJSACOP MID‐YEAR MEETING ATTENDEE REGISTRATION FORM
ATTENDEE INFORMATION Attendee Name _____________________________________________________ Rank : __________________________________ Department : ____________________________________________________________________________________ Address : _______________________________________________________________________________________ Telephone : _______________________________________ E-mail ________________________________________
REGISTRATION FEE : $ 165.00
( 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 : ( 856 ) 334-8943 ● Fax : ( 856 ) 334-8947 Web : www . njsacop . org
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