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]
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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.
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