NJ-NENA CONFERENCE REGISTRATION
April 23 & 24, 2009

Registration Fee: $150.00

Field names in Red are required
First Name:
  Last Name:
 
Badge Name: (First name as you would like it to appear on your badge)  
Title:
  Agency/Company:
 
Address:  Address 2:
 
City:
  State: Zip:
Phone # Ext.  Fax #
e-mail address:  
NENA Member: Yes    No Membership Number:
Check the box that is applicable:
I am an exhibitor:        I am an attendee: 		I will attend the Welcome Reception:
Yes:    No:

THREE FOR TWO BY 3/2

Any two attendees from the same agency registered and paid for by March 2, 2009 are entitled to bring a third guest from the same agency for free. A third registration form MUST BE SUBMITTED, marked "3 for 2 third person" in the payment box.

This offer applies to full registrations only. One day passes are not applicable.

Voucher, purchase orders and checks made payable to NENA - New Jersey Chapter must indicate the names of all attendees and should be mailed immediately to:

NENA New Jersey Chapter Conference
203 Main Street - PMB 247
Flemington, New Jersey 08822

Credit card payments must be made through PayPal by clicking on the link on the home or conference page. Please do this immediately upon submission of this form.

  METHOD OF PAYMENT

Voucher  #
Purchase Order #
Check #
Credit Card Conf #
3 for 2 third person

REFUND POLICY

Refunds will be given only prior April 1, 2009. No refunds will be made after that date! If the registered attendee cannot attend, a substitution may be made.

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