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Please Note: If you are registering as an NJCSG Member and also registering
additional non-members, you must complete separate registration forms
and click on the appropriate Member or non-member payment buttons
on the payment page. Thank you.

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Name *

E-mail Address *

Company Name *

Address *

Daytime Phone Number *

Mobile Phone Number

Fax Number *

Number of e-Vent Attendees * 1 2 3 4 5

Name of additional Attendees

How did you hear about the NJCSG e-Vent? N.J.C.S.G. website

N.C.S.G. website

SNEWS Magazine

Sweeping Magazine

Received e-mail from the N.J.C.S.G.

From another Chimney Service Professional

Are you a member of the following? The N.J.C.S.G.

The N.C.S.G.

The N.F.P.A.

N.A.O.H.S.M.

The H.P.B.A.

The I.A.F.C.I.

Another State Guild (list below)

Other Memberships (list below)

Other Memberships:

Current Certifications Held: C.S.I.A. Certified Chimney Sweep

F.I.R.E. Certified Inspector

N.F.I. Woodburning Specialist

N.F.I. Gas Specialist

N.F.I. Pellet Specialist

I.A.F.C.I. Certified Professional Inspector

Other (list below)

Other Certifications

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