The NJ Police Chief Magazine Volume 25, Number 4

June 12, 2019 ATTENDEE INFORMATION Name: _______________________________________________________________ Title: ________________________________________________________________ Agency: _____________________________________________________________ Address: _____________________________________________________________ City: ___________________________________ State: _________ Zip: __________ Phone/Fax/E-Mail: _____________________________________________________ _____________________________________________________ FEE: $95.00 Choose one of the following methods of payment: CHECK Make Checks payable to NJSACOP Command & Leadership Alumni Association Mail full payment (no cash) with completed registration form to: NJSACOP, 751 Route 73 North, Suite 12, Marlton, NJ 08053 P.O./VOUCHER Make payable to NJSACOP Command & Leadership Alumni Association NJSACOP, 751 Route 73 North, Suite 12, Marlton, NJ 08053 CREDIT CARD Please indicate by circling: VISA MASTERCARD AMEX Fax this registration form with credit card authorization to 856-334-8947 NJSACOP Command & Leadership Alumni Association 751 Route 73 North, Suite 12 Marlton, NJ 08053 P/856-334-8943 F/856-334-8947 DO NOT MAIL AND FAX THIS FORM—Charges will be duplicated. Account Number: ______________________________________________________ Expiration Date: ________________________CC Security Code________________ Cardholder’s Signature: _________________________________________________ Address: _____________________________________________________________ City/State/Zip: ________________________________________________________ COMPLETE AND RETURN REGISTRATION FORM WITH FEES Cancellations must be received by May 15, 2019 to receive a refund. A confirmation will be sent prior to the event. 34

The NJ Police Chief Magazine Volume 25, Number 4 | Page 35