15th Annual Addiction Conference Registration Form Logo
Conference Registration

15th Annual Addiction Conference
Please register me for "The Building a Stronger Foundation," NJPN's 14th Annual Addiction Conference, taking place on Friday, March 06, 2015, at the Atlantic City Convention Center. (NJPN will validate your Atlantic City Convention Center parking fee.)

Registration Fee :
Registration Fee : Registration: $100.00
Registration Fee :
Registration Fee includes all plenary and workshop sessions, continental Registration Fee : breakfast, lunch, breaks and conference educational materials.

Attendee Information
* Required Information
*First Name:   *Last Name:
Organization:
*Mailing Address:
*City:   *State:   *ZIP:   *County:
*Email Address:
*Confirm Email Address:   *Phone:
*Conference Lunch Information:
Note: Specific details about lunch menu will be posted on NJPN website as it becomes available. Please know the caterers cannot address all special dietary requirements. If you do have a health-restrictive diet, for your safety, NJPN recommends bringing supplemental food with you to the conference.
*Do you need a sign language interpreter?
*What is your Agency's primary focus:



*Are you a member of your Local Municipal Alliance?
Demographic Information (Optional)
Gender:
Age:
Please select one of the following that best describes you:



Payment Information


Registration Confirmation Information
Payment is required for registration. This application is not complete and space is not reserved until payment is received. When payment is processed a registration confirmation will be emailed to the address entered above. Credit Card Payments will be processed immediately once payment has cleared. Registration by Purchase Order or by Check will be confirmed after PO paperwork or Check is received and processed. After February 14, On-Line Registration will be limited to credit card payments only. All cancellations must be made before Friday, February 21, 2014 for a refund. After 2/21/14 all cancellations or no-shows will require full payment. Substitutions are always accepted. For Substitution, Cancellation, and Refund policies, please consult Conference FAQ page, at njpn.org.