Registration for the NJPRA 2007 Conference

Agenda: Thursday or Friday

Registration for the NJPRA 2008 Conference

Personal information

First Name
Last Name
Title
Agency
Street Address
City, State, Zip
Email address
Phone

Early Bird Fees - Through October 31st

Choose one: *All memberships must be current at the time of the conference to get the member rate. If yours is expiring, please re-join to get the member rate.*
	Individual NJPRA or USPRA Member
	NJPRA Organizational Member**
	All Non-members
	Advocate***

**For information about Organizational Memberships, call NJPRA at (908) 757-8170.
***Advocate rates are intended for members of NJPRA who are consumers, family members, or full-time students who are not working in a professional capacity.

Lunch selection Choose one lunch for each day you are attending the conference.

Payment

Choose type of payment
If paying by credit card, please complete information below.
Name on Card
Billing Address
Card Number
Expiration Date
CVV2# (3 digit pin on back of card)

New Jersey Psychiatric Rehabilitation Association:

551 Valley Road, Upper Montclair, NJ 07043

voicemail: (908) 757-8170 fax: (973) 450-1189 info@njpra.org