New Jersey State Association of Chiefs of Police 100th
Annual Training Conference June 25 - June 28, 2012
Trump Taj Mahal & The Atlantic City Convention Center BREAKFAST REGISTRATION FORM
This form to be used for additional personnel attending the Breakfasts & Seminars only. Tuesday, June 26, 2012 Breakfast & Seminar
“BI LOKA (L F E aw E nforcemn ff et O icers Ki d & Asau lle s lted rogram - Of e afe ) P Seminar: 9:00am - 11:00am ficr S ty & S iv
Presenter: Chief William D. Baker, Retired, FBI, Criminal Justice Information Services Division Breakfast: 7:45am - 9:00am
Attnde) @ $0 pr pe on e e(s 5 e rs :
Title ___________ Name ______________________________________________ ___________ ___________
______________________________________________ ______________________________________________
Department ___________________________________________________________ Chief’s Name __________________________________________________________ Chief’s Signature (Required) ______________________________________________ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Wednesday, June 27, 2012 Breakfast & Seminar “
S iv g Dady E ou r” urv in e l nc ntes Presenter: Chief John Bouthillette, South River Police Dept. Breakfast: 7:45am - 9:00am Attnde) @ $0 pr pe on e e(s 5 e rs :
Title ___________ Name ______________________________________________ ___________ ___________
______________________________________________ ______________________________________________
Department ___________________________________________________________ Chief’s Name __________________________________________________________ Chief’s Signature (Required) ______________________________________________ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Payment information - Total Enclosed: $___________ Make checks, money orders, purchase orders/vouchers payable to & return to: New Jersey State Association of Chiefs of Police One Greentree Centre, Suite 201 Marlton NJ 08053
Seminar: 9:00am - 11:00am urv al Trai n”nig
Tel: 856/988-5880 Fax: 856/810-0223
Credit card information - MasterCard__ Visa__ AmEx__ Card# _______________________________________ Exp. date ____/____
Signature ____________________________________ Billing address of credit card holder ____________________________________________________________ Yu ofeec ei ao es ae nt ta eutil s a cai be cniuo. or cn rne rgstrtin fe r o x ddcbe a hrtal otrbtin 23
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