19th Annual Addiction Conference Registration Form Logo
REGISTRATION IS NOW CLOSED.

Conference Registration

19th Annual Addiction Conference
Please register me for "Creating Connections," NJPN's 19th Annual Addiction Conference, on Friday, May 10, 2019, at the Atlantic City Convention Center. (NJPN will validate your Atlantic City Convention Center parking fee.)

Registration Fee :
Registration Fee : Registration: $125.00 (fee increases to $125 on April 15, 2019)
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?
*Do you need accessible parking? Accessible Parking
*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
This application is not complete and space is not reserved until payment is received or scholarship confirmed. When payment is processed a registration confirmation will be emailed to the address entered above. Registration by Credit Card Payments will be processed immediately. Registration by Purchase Order or by Check will be confirmed after PO paperwork or Check is received and processed. After April 1, 2019, Online Registration will be limited to credit card payments only. All cancellations must be made before Wednesday, May 1, 2019 for a refund. After May 1, 2019, 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.