Registration for:

Academy of Pacesetting States
July 19-24, 2009
Princeton, NJ


Please enter registration information.
Title and name (first, last):          
How would you like your name to appear on your name badge? 
Organization: 
Position:
Address (1): 
Address (2):  
City, State, ZIP:                  
Country:     Phone:    Extension:
Alternate Phone:         Fax:
Email:       
Alternate Email: 
Are you a member of the Academy faculty? 
Are you a member of a State Team?    If yes, what is your role?   (choose one from list)
 


             





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