2025 NCASRO Conference Registration Form

2025 Conference Registration Form

Please fill out this form carefully, ensuring your name matches the spelling on your NCJA Portal Account. If registering multiple attendees, please use each person's email address. They will receive important conference information and updates throughout the year.
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*
Agency*
Agency Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Agency Number*
Region:*
Shirt Size*
How will you be paying your registration fee of $300?*

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.
Is this your first time attending the NCASRO Conference?*

YesNo
Additional Comments (special dietary needs, etc...)
Should be Empty:

2025 Conference Registration Form