NECNA and the Federal Bureau of Investigation Present the
10th Annual New England Crisis Negotiators Conference
REGISTRATION FORM - PAY BY CHECK
April 26 - April 28, 2010
Ocean Edge Resort & Golf Club Brewster Massachusetts 02631
Register early - $25 late fee if received after March 7, 2010
Seating is limited and therefore could be filled prior to March 9, 2010
- All registration information will remain strictly confidential - |
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Are you currently a 2010 NECNA member in good standing?* Yes No
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APPLICANT *required
First Name*
Last Name*
Position/Title/Rank*
AGENCY / ORGANIZATION
Agency/Organization Name*
Additional Comments
Purchase Order Number
Billing Contact Name
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BUSINESS ADDRESS *required
Address 1*
Address 2
City*
CONTACT INFORMATION
(for registration purposes only)
Phone Work: (include area code)*
Cell Phone: (include area code)
Fax: (include area code)
E-mail*
Confirm E-mail*
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Will you be attending the dinner?* Yes No
1 free dinner is included in price. $30 for each additional dinner.
Click below if you would like to add a dinner.
1 Additional Dinners - $50 2 Additional Dinners - $100
3 Additional Dinners - $150 No Additional Dinners
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$ to be Paid
($25 Late fee if Purchase Order Payments are not received prior to March 7th, 2010)
For all mailed registrations, Registration form must be accompanied
by check or Purchase Order.
Make Check or Purchase Order payable to:
NECNA
PO Box 951, Andover, MA 01810 |
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Once payment is approved, you will receive an email confirmation. |