| Course
Registration Form
Fundamentals
and Advanced Course for the
Investigation and Prosecution of Domestic Violence Cases
Tuesday,
January 5 through Thursday, January 7, 2010
(8:00 a.m. - 5:00 p.m.)
Richard Stockton
College of New Jersey, Pomona, New Jersey
Registration payments are due
on or before December 11, 2009
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| Course
Attendee Agreement and Information
please submit a separate
form for each attendee |
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| Prefix |
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First
Name |
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| Middle
Initial |
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Last
Name |
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Title/Rank |
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Employing
Agency |
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Agency
Address 1 |
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Agency
Address
2 |
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City |
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NJ
County* |
*for
NJ residents only |
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State |
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Code |
-
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Agency
Phone |
Ext.
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Agency
Fax |
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Home
Phone |
(for emergency use only) |
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E-Mail |
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Verify E-Mail |
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Registrants MUST RECEIVE a confirmation
packet in order to attend this course. Confirmation packets
will be sent by December 18, 2009 to the agency address.
If you have not received confirmation by this date contact
Jessica at (609) 292-8249 or guglichj@njdcj.org
to confirm your enrollment. People who are not confirmed
as registered will not be allowed to attend the course.
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| Please
contact 609-292-4791 if you experience any technical issues
with this form |
