Conference Registration
12th
Annual Addiction Conference
Please register me for the
"Strategic Moves": Advancing the Field of Addiction
Conference taking place
Friday, March 02, 2012
at the Atlantic City Convention Center. NJPN will validate parking fee.
Registration Fee :
Early Registration: $85.00 if payment is received by 12/30/2011
Registration Fee :
Regular Registration: $100.00 if payment is received after 12/30/2011
Registration Fee :
Includes workshops, continential breakfast, lunch, and conference materials.
Attendee Information
* Required Information
*
First Name:
*
Last Name:
Organization:
*
Mailing Address:
*
City:
*
State:
*
ZIP:
*
County:
*
Email Address:
*
Confirm Email Address:
*
Phone:
Demographic Information (Optional)
Gender:
Male
Female
Age:
18-25
26-44
45-59
60+
Please select one of the following that best describes you:
Native American/Alaska Native
Black/African American
Native Hawaiian & Pacific Islanders
Asian
Hispanic/Latino
White/Caucasian
Other
*
Do you need a sign language interpreter?
Yes
No
*
What is your Agency's primary focus:
Substance Abuse Prevention
Substance Abuse Treatment
Education
Law Enforcement
Military
Health/Human Services
Mental Health
Business
Healthcare
Other
*
Are you a member of your Local Municipal Appliance?
Yes
No
Payment Information
Early Registration: $85.00 if payment is received by 12/30/2011
Regular Registration: $100.00 if payment is received after 12/30/2011
Payment Method:
Purchase Order
Credit Card
Check (Please make check payable to: NJPN)
Please wait...
No Refunds on cancellations received after
Friday, February 17, 2012
All cancellations received after this date and/or no shows will still require full payment.