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