CAMPS REGISTRATION FORM

Question Title

* Please enter your contact information:

First Name

Last Name

Work Phone Number

Job Title

Work E-Mail

Question Title

* Please enter your employer's information (no abbreviations):

Agency:

Street Address:

City:

State:

Zip:

Question Title

* Please enter your Fiscal Officer's contact information:

Name:

Email:

Phone Number:

Street Address:

City:

State:

Zip:

Question Title

* Do you currently have a log on ID for CAMPS?

Yes

If you selected 'No', is there an ISR designated for your agency? If yes, then enter their name, email address and phone number below. If there is no ISR in place, then enter 'No ISR'

Question Title

* Please select the class you would like to attend (1st Choice). Add a 2nd Choice in case your 1st Choice is not available.

	1st Choice	2nd Choice
County College of Morris: Thursday - September 11, 2014	County College of Morris: Thursday - September 11, 2014 1st Choice	County College of Morris: Thursday - September 11, 2014 2nd Choice

Question Title

* By submitting this registration form you are certifying that you have approval from your employer to attend this training class at a cost of $75. I understand that any cancellations will need to occur at least seven (7) business days prior to the class date to avoid incurring the $75 fee.

Signature (type full name)

Date (mm/dd/yy)