2024 NCASRO Conference Registration Form

2024 Officer Registration Form

Fill out the form carefully, and spell your name the same as your NCJA Portal Account.
Officer Name*

First NameMiddle InitialLast Name
Birth Date*

MonthDayYear
Last 4 of SSN*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Officer E-mail*
example@example.com
Mobile Number*
Format: (000) 000-0000.
Agency*
Agency Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Agency Number*
Format: (000) 000-0000.
Region:*
Shirt Size*
In person at the conference.By check mailed to PO Box 5296 Statesville, NC 28687Online
If you chose "Online" please enter the name of the person that will be making the payment. We frequently have payments made by the department's training officer, supervisor, or financial secretary that do not include the name of the officer they are paying for which complicates the process of finalizing the accounts payable.
YesNo
Additional Comments (special dietary needs, etc...)
Should be Empty:

2024 Officer Registration Form