Registration Form
Please complete the following information and print using the button below. This form may be used to register up to four individuals. For additional registrations, please use additional forms.

PLEASE NOTE: This is not an electronic registration - you must print the completed form and mail with payment to the address below.

Name(s):


Affiliation:

Address:
Street1:
Street2:
City, State, Zip:
Daytime Phone: - -
Email Address:

Yes, I will be attending the Closing Reception.

I would like to attend a field workshop: (select one): Walt Whitman's Camden Underground Railroad
Each field workshop is limited to 26 participants and is available on a first come first served basis
(both registration form and payment must be received to enable field workshop participation).

Friday Conference - $65 (Includes conference materials, sessions, exhibitors, refreshments, lunch and reception)
Please Note: DOES NOT INCLUDE PARKING (Nearby garage additional $7.50)
All checks or money orders must be made out to: Treasurer, State of New Jersey
(No credit cards accepted)

Accessibility: The Terminal is ADA accessible. If you have any special needs, please contact the Historic Preservation Office in advance so that we can best assist you.

Mail the Completed form with payment to:
2006 Annual Historic Preservation Conference
c/o NJ Historic Preservation Office
P.O. Box 404
Trenton, NJ 08625-0404
State of New Jersey
John S. Corzine, Governor
Department of Environmental Protection
Lisa P. Jackson, Commissioner