Pioneer Dinner Registration Form

The NJESA 50th Anniversary Gala Dinner Event

Pioneers of the New Jersey Security Industry

to be honored at a special gala dinner October 5 at Caesar’s Palace, Atlantic City
Reception starts at 6:00 P.M. and dinner will follow

Dinner Registration Form

(RSVP and pre-registration required)
This exciting event with a cocktail hour with open bar* and a sumptuous sit down dinner with open bar* is $99.95 per person. Discounts are available for group tables. Please complete the form below and return it ASAP!
Click here for more info and the Pioneer Award Nomination form.

Registration includes reception hour with open bar*, an elegant dinner and open bar* is $99.95 per person.

Group table for 10 people $99.95 per person @ 10% discount. Bring your family and colleagues!

I am interested in being a sponsor - please contact me or click here for the online form

I have a lot of alarm antiques and would like to have a free table (during the reception hour with open bar*) to show it off.

Number of Persons

Total

Total:

Group Table Selection (10 people to a table)

Group Table Total

Total:

Billing Contact Name

Billing Address

Billing Suite

Billing City

Billing State

Billing Zip

Billing Phone Number

Billing Fax

Billing Email Address

Payent Method

Will send by mail to the NJESA Office (and payable to the NJESA)

Check Money Order

Total for Check or Money Order

Total for Credit Card

Charge my

Visa MasterCard American Express

Total Amount (to be billed to my credit card)

Credit Card Number

Expiration Date

CVV

Signature (please print your name)

Privacy Policy: NJESA does not collect any personal identifying information about you unless you specifically and knowingly provide such information. Contact information provided to NJESA may be used to send information about NJESA or ESA programs, events, opportunities, or other useful information.

NJESA may share contact information with associate members and other companies that offer NJESA member benefits and programs. NJESA will not share contact information with any other company, group, or organization that is not affiliated with the association for the sole intent of using such information for marketing purpose.

The undersigned represents all information submitted is accurate; false information may result in denial or revocation of membership. If approved, the undersigned agrees to comply with the NJESA bylaws, Standards of Conduct, code of ethics and antitrust statement. NJESA may deny membership regardless of any payments submitted.NJESA may share contact information with associate members and other companies that offer NJESA member benefits and programs. NJESA will not share contact information with any other company, group, or organization that is not affiliated with the association for the sole intent of using such information for marketing purpose.

The undersigned represents all information submitted is accurate; false information may result in denial or revocation of membership. If approved, the undersigned agrees to comply with the NJESA bylaws, Standards of Conduct, code of ethics and antitrust statement. NJESA may deny membership regardless of any payments submitted.

Dinner Registration Form

Total:

Total:

Payent Method

Nominee:

Nominated By: