New Jersey Division of Consumer Affairs - Legalized Games of Chance Control Commission

Please fill out the form below to request a Legalized Games of Chance Control Commission (L.G.C.C.C.) "Out Reach Program" speaker for your organizations's seminar or meeting.

* Indicates Required Field

Name of Organization:

Contact Person:

Organization Address:

City:
State: ZIP Code:

Telephone Number(s):
Day: Cell:

E-Mail Address:

1. Is your organization registered with L.G.C.C.C.:
Yes No

2. If yes, please provide the L.G.C.C.C. identification number:

3. Interested topic(s) for discussion:

4. List, if any, names of participating organizations to be present:

5. Number of attendees:

6. Date and time of engagement:

7. Anticipated start time for L.G.C.C.C. presentation:

8. Location and Address of engagement:


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