CHARGE IT:
In response to numerous requests, the NGCRC now takes all major credit cards, defined specifically as the "big four": Visa,
Master Card, Discover Card, and American Express. Fill out the registration form, and fax it to the NGCRC: the fax number for
the NGCRC is (708) 258-9546
A registration form appears below:
THE 2012 NGCRC's 15th INTERNATIONAL
GANG SPECIALIST TRAINING PROGRAM
REGISTRATION FORM: Before Dec. 31, 2011
On-Line Version
Please PRINT neatly or type your full name with any title that you want to appear in your official name badge for the
conference.
I.D. Badge Information:
NAME:___________________________________________
Title:_____________________________________________
Agency:__________________________________________
City,State:________________________________________
MAIL AND CONTACT INFORMATION: Where we will mail you a Confirmation of Registration letter for the
conference, and fax the same material to you:
Name:___________________________________________________________
Agency :__________________________________________________________
Street Address:____________________________________________________
City, State, Zip:____________________________________________________
Tel. #. Area Code_______ Tel #:____________________
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Fax #. Area Code_______ Fax #:____________________
Email Address:____________________________________
I want to be included in the printed conference directory, a copy of which is given to every person attending the NGCRC
conference? ____Yes ____No
The NGCRC reserves the right to refuse service to anyone: Towards this end we must ask that all persons registering for the conference sign and by their signature
acknowledge the Official Policy of the NGCRC which is as follows - In order to provide the safest and most educational environment, the National Gang Crime
Research Center (NGCRC) works to ensure that all participants at our conference are law-abiding individuals who have gathered to collect and share information about
gangs and crime, in order to reduce and possibly eliminate the problems associated with gang activity. Therefore, it is our policy that no individuals or groups will be
permitted at our conference who have links to gangs or other aberrant groups and no one will be permitted to provoke or distract our participants from the most
meaningful learning environment. The National Gang Crime Research Center (NGCRC) reserves the right to refuse attendance to any person or persons suspected of or
actually displaying gang affiliations. Furthermore, we reserve the right to refuse attendance to any individual(s) determined to be disruptive or instigating a negative or
inappropriate presence or who is determined to disrupt the sharing of information in the most effective learning environment. I have also read and understand the refund
policy published by the NGCRC. I attest that I am at least 18 years of age as of this date.
I hereby acknowledge by my signature the above policies of the
NGCRC:_________________________________________________________________________________________________
I would like to attend the Christian Gang Specialist Reception ___Yes ___No (if blank, we assume you mean "NO")
I work in either law enforcement or corrections and I would like to attend the Law Enforcement and Corrections
Networking Reception: ____Yes ____No (if blank, we assume you mean "NO")
I want to attend the Intervention/Prevention/Counseling Gang Specialist Networking Reception ____Yes ____No (if blank,
we assume you mean "NO")
I want to attend the full Mental Health First Aid (MHFA) Certification Course (12 of my 24 hours) at this training conference.
___Yes ___No
I am registering for (check appropriate box):
___Non-certification ___Certification ___One Day Pass (pick which day: ___Monday ___Tuesday ___Wednesday)
If registering for Certification, Complete this section ONLY if you have previously been Certified by the National Gang
Crime Research Center at any of the previous NGCRC International Gang Specialist Training Conference(s). I received
NGCRC certification from (check one or more as may apply in your situation):
___First International ___Second International ___Third International ___Fourth International ___Fifth International
___Sixth International ___Seventh International ___Eighth International ____Ninth International ____Tenth
International ___Eleventh International ___Twelfth International
___Thirteenth International ___Fourteenth International
SPECIAL TRAINING TRACKS (If you are registering for Certification, you also need to complete this section): CHECK
ONE ONLY (this is for your second certificate described elsewhere in this brochure):
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_____ Gang Crime Investigation Skills Track
_____ Gang Homicide Investigation Skills Track
_____ Domestic Counter-Terrorism Skills Track
_____ Gangs and Mental Health Track
_____ Gang Profile Analysis Track
_____ Gang Interview/Interrogation Skills Track
_____ Gangs and Drugs Track
_____ Gang Prosecution Track
_____ Corrections Gang/STG Intelligence Track
_____ Gang Prevention Skills Track
_____ Gang Problems in K-12 Schools Track
_____ Faith-Based Programs for Gang Intervention Track
_____ Officer Safety Skills in Dealing With Gangs Track
_____ Gang Counseling Techniques Track
_____International and Transnational Gang Problems
_____Gangs and Organized Crime
_____ Gang Arson Investigation Skills Track
_____ Hate Group/White Racist Extremist Gangs Track
_____ Dealing With Gang Members in Probation/Parole Track
_____ Advanced Gang Identification
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_____ Gang Internet Investigation
_____ Management and Supervision Skills for Gang Specialists
_____ Motorcycle Gangs (restricted to Law Enforcement ONLY)
_____Female Gangs
_____Gang Program Grantwriting/Fundraising Skills
_____Gangs and the Mass Media
_____Spatio-Temporal Gang Analysis Skills
_____Dealing With Gangs in Juvenile Correctional Facilities
_____Gang and Violence Prevention for School Administrators
_____Gangs in the Military
Your registration fee does not cover your hotel room or parking or meals. Your registration fee covers only the training
itself.
Amount to pay for Registration (see schedule below):
EARLY REGISTRATION PERIODS:
Paying on or before December 31, 2011: Non-Certification $550, Certification $650
REGULAR REGISTRATION PERIODS:
Paying on or After January 1 and on or before February 28, 2012: Non-Certification $650 Certification $700
Paying on or after March 1, 2012 and on or before May 31, 2012: Non-Certification $700 Certification $750:
LATE REGISTRATION PERIODS:
Paying on or after June 1, 2012 and on or before June 30, 2012: Non-Certification $750 Certification $800
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Paying on or after July 1, 2012 and on or before July 20, 2012: Non-Certification $800 Certification $850:
ONSITE REGISTRATION:
Paying On-Site (if slots are available): Non-Certification: $900 Certification $950
Price for the One Day Pass: $295.00
I am signing up for the Double Major option (where I get two certificates in the two different specialty areas, it requires me to log-
in at least four hours in each track or specialty area, and I have enclosed an extra $90 for this option). ____Yes ____No
If yes regarding the Double Major, my second training track will be: (fill it in here)
______________________________________________________________
Note anyone registering on-site: we reserve the right to refuse on-site registration to anyone for any reason. You will need
USC, money order, traveler’s checks, bank check, cashier's check, or government agency check to pay onsite.
Note: you know you are registered for the conference if and only if you receive from the NGCRC an official “Conference
Registration Confirmation” letter; we send these out PROMPTLY to all persons; so if you have not received one, you are
not registered.
NOTE: Payment must be received by the NGCRC prior to the conference itself unless the NGCRC agrees to the terms of
any alternative arrangement (in writing).
Group Discount Code:_____________
PAYMENT METHOD: We prefer checks or money orders for payment. No personal checks will be accepted for on-site
payment of conference registration fees. We do accept credit card payments.
_____Payment enclosed in check or money order made payable to "National Gang Crime Research Center"
_____VISA, MasterCard, American Express or Discover (Circle one).
Card number:___________________________________________________________________________
Expiration date: Month___________________________ Year:_________________________________
If this is a Mastercard, what is your Customer Number:_________________________________
Name on card: (printed):___________________________________________________________________
Your Signature:________________________________ Amount you authorize to charge (total):__$______________
Billing Address for the card holder(Printed): (street address)
__________________________________________________________
Zip Code for the Billing Address:__________________________________
Call (708) 258-9111 if you need the NGCRC F.E.I.N. (tax number) or our Merchant Number for credit card payments. Also, call
(708) 258-9111 if you want to provide credit card info by verbal rather than written transmission.
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Registration forms can be faxed to the NGCRC, the Fax Number is (708) 258-9546.
Make checks or money orders payable to "National Gang Crime Research Center". Make sure to mail a copy of your
registration with the payment so that proper credit can be made to your registration. Send registration forms and payment
to: The 2012 Conference Processing Center, National Gang Crime Research Center, PO Box 990, Peotone, IL 60468-0990.
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