The NJ Police Chief Magazine Volume 25, Number 3 | Page 11

NEW JERSEY STATE ASSOCIATION OF CHIEFS OF POLICE FOUNDATION FOR EXECUTIVE LEADERSHIP National Conference Center / Holiday Inn East Windsor, New Jersey Monday, November 18—Friday, November 22, 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 P/ 856-334-8943 F/ 856-334-8947 E/ [email protected] ******** COST: $1,100. 00 per attendee 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 Name on Credit Card: _______________________________________________________________ Credit Card #: _____________________________________________________________________ Expiration Date: _________________ Security Code: __________ Billing Address: ___________________________________________________________________ City/State/Zip: ____________________________________________________________________ ________________________________________ Signature ____________________ Date ________________________________________ Chief’s Endorsement/Signature    Deadline for Registration: October 8, 2019 [space permitting] Registrants will receive a confirmation prior to the course Cancellations must be received by September 14, 2019 in order to receive refund. 10