The NJ Police Chief Magazine Volume 25, Number 3 | Page 17

N EW J ERSEY S TATE A SSOCIATION OF C HIEFS OF P OLICE THREE DAY PROGRAM—SEE AGENDA FOR TIMES AND LOCATIONS. FRIDAY, OCTOBER 4TH—SUNDAY, OCTOBER 6TH FEE: $725.00     PLEASE DUPLICATE THIS FORM FOR EACH REGISTRANT. REGISTRATIONS MUST BE PAID IN ADVANCE BY CHECK OR PURCHASE ORDER. YOU WILL RECEIVE AN E-MAIL CONFIRMATION WITH HOTEL INFORMATION PRIOR TO THE EVENT. CANCELLATIONS MUST BE RECEIVED 14 BUSINESS DAYS PRIOR TO THE COURSE IN ORDER TO BE ISSUED A REFUND. THE SEMINAR MAY BE CANCELED DUE TO INSUFFICIENT ENROLLMENT. RETURN THIS FORM TO: NJSACOP 751 ROUTE 73 NORTH, SUITE 12 MARLTON, NJ 08053 FAX #: 856.334.8947 NAME: TITLE/RANK/POSITION: AGENCY/DEPARTMENT: ADDRESS: CITY/STATE/ZIP: TELEPHONE: FAX: E-MAIL ADDRESS: (confirmations will be sent via e-mail) METHOD OF PAYMENT: ___ CHECK ENCLOSED ___ PURCHASE ORDER CREDIT CARD: ___ VISA ____ MASTERCARD ___ AMEX CREDIT CARD #: ___________________________________________________________________ EXPIRATION DATE: _______________ CVV: ____________________________________________ BILLING ADDRESS: _________________________________________________________________ ______________________________________ SIGNATURE ____________________________ DATE 16