The NJ Police Chief Magazine Volume 24, Number 9 | Page 13

NEW JERSEY STATE ASSOCIATION OF CHIEFS OF POLICE 06 July — 14 July 2019 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 ******** COST: $1,995 per attendee REGISTRATION FORM Name: ______________________________________________________________________ Rank/Title: ______________________________________________________________________ Agency: ______________________________________________________________________ Address: ______________________________________________________________________ City: ___________________________________ State: _________ Zip: _____________ Phone/E-Mail: ________________________________________________________________ PAYMENT: Form of Payment: Check ___ Purchase Order ___ Credit Card: __Visa __ Mastercard __ AMEX Credit Card #: _____________________________________ Expiration Date: _________________ CVV: _______ Billing Address: ___________________________________________________________________ City/State/Zip: ____________________________________________________________________ ________________________________________ Signature ____________________ Date 12