April 13, 2017


ATTENDEE INFORMATION Name: _______________________________________________________________ Title: ________________________________________________________________ Agency: _____________________________________________________________ Address: _____________________________________________________________ City: ___________________________________ State: _________ Zip: __________ Phone/Fax/E-Mail: _____________________________________________________


YOU MUST BE AN ACTIVE ALUMNI ASSOCIATION MEMBER TO ATTEND THIS EVENT


FEE: $130.00 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


DO NOT MAIL AND FAX THIS FORM—Charges will be duplicated. Account Number: ______________________________________________________ Expiration Date: _______________________________________________________ Cardholder’s Signature: _________________________________________________ Address: _____________________________________________________________ City/State/Zip: ________________________________________________________


SPACE IS LIMITED


COMPLETE AND RETURN REGISTRATION FORM WITH FEES


Cancellations must be received by March 1, 2017 to receive a refund.


A confirmation with a detailed agenda will be sent prior to the event.


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