September 18-20, 2003 Bridgewater Marriott Bridgewater, New Jersey

Registration is on a first come first serve basis until quota of 450 participants is reached. Each person attending the conference must register in advance. There will be no exceptions.

COMPLETE THE FOLLOWING. PLEASE PRINT.

Name: ____________________________________________________________

Organization: _______________________________________________________

Address: __________________________________________________________

City: _____________________________ State: _________ Zip Code: _________

Telephone: (_____) _________________ Fax: (_____) ______________________

E-mail: ___________________________________________________________

Preferred name on badge: ____________________________________________

The conference registration fee includes: 2 continental breakfasts (Thursday & Friday), 2 lunches (Thursday & Friday), breakfast on Saturday, refreshment breaks, access to all exhibits, workshops, and program materials.  Dinners are on your own. A beach party barbecue dinner is planned for Thursday evening off-site in Point Pleasant Beach, New Jersey about one hour away. You must pre-register for this event. The cost is $15 per person which covers cost of bus transportation, dinner, and entertainment.

PLEASE CHECK:

Early Registration by July 1	$          85
Late Registration after July 1	100
One Day Registration Fee includes lunch and conference give-away	55
CHECK DATE ATTENDING:    9/18    9/19    9/20
Thursday Night Dinner (September 18, 2003 in Point Pleasant Beach)	15
Total	$________
Yes, I am interested in participating in a 9-hole golf outing on Friday after workshops.
Yes, I am interested in a tour of a winery on Friday after workshops.

PRE-REGISTRATION FOR SATURDAY SEPTEMBER 20 CLASSES:

Yes, I want to be signed-off by an instructor on technical skills for re-certification.

Yes, I want to register for the CPS Pupil Transportation Train-the-Trainer Class.

Yes, I want to register for the CPS Update/Refresher Course.

• Registration fees must be paid by check payable to: NJAC Foundation for Safety & Education
• Return completed form with check to Debbie Lotito at the following address:
  Governor's Traffic Safety Committee, 6 Empire State Plaza, Room 414, Albany, NY 12228
• Registration forms without an attached check will be returned.
• Cancellations made prior to September 1, 2003 will receive refund. No Refunds after September 1st.