State Data Center Conference Registration Form

The Great Seal of the State of New Jersey

NEW JERSEY STATE DATA CENTER 27TH ANNUAL CONFERENCE

DECEMBER 1, 2006

TRENTON MARRIOTT HOTEL, TRENTON NJ

REGISTRATION FORM

(Please submit by November 22nd, 2006)

Registration Fee: (Includes Continental Breakfast, Break Refreshments, Luncheon and Conference Materials)

By November 22nd: $95.00

at the door: $105.00

Parking: Parking Garage for Hotel located on South Warren Street.

Parking vouchers will be available at the registration table.

Cancellation Policy: Payment will be required for all reservations canceled after November 22, 2006.

Registration information
**
(First, Middle, Last)
Given first and last name of applicant
**
specific name of the company/agency applicant works for
**
(Street)
(Address Line 2)
(City, State, Zip as nnnnn-nnnn or nnnnn)
mailing street address of applicant
**
(First, Middle, Last)
Given first and last name of applicant
**
mailing street address of applicant
**
(Street)
(Address Line 2)
(City, State, Zip as nnnnn-nnnn or nnnnn)
specific name of the company/agency applicant works for
**
(First, Middle, Last)
Given first and last name of applicant
**
specific name of the company/agency applicant works for
**
(Street)
(Address Line 2)
(City, State, Zip as nnnnn-nnnn or nnnnn)
mailing street address of applicant
**
contact number to reach applicant
(333)333-3333
fax number to reach applicant
(333)333-3333
electronic mailing address to contact the applicant
yourname@abc.com
type of lunch during the event
account number used by the state to identify agencies
contact information regarding the applicant
Description of the necessary items or services needed during the event

(** indicates a required field)

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