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					    Certificate of Training in Adult Weight Management
                                                          Program Registration                                                                                           Zantr~rc
                                                                                                                                                                    rl~t Association
S                                                                                                                                                                            120 scud, Ri.,nide PI.za
                                                                                                                                                                             suise 2000
                                                                                                                                                                             Chicago, illinoIs 606064995
    ADA MembershlpiReglstratlon number:                              _____________                                                                                           600Th” Ieooestssoo
    Participation is limited. Please register by the date I sted below           Past certificate programs have been filled to capacity several days prior to the registration
    deadline       CDR strongly recommends that flight arrangements and hotel reservations not be finalized until written registration confirmation is received
    Registration confirmation wilt be sent by e-mail Please be sure to include an e-mail address below The registration fee is $345. Registration includes the home study module, 2
    1/2 day onsite workshop—including beverage breaks and post-test Meals are not included) A complimentary copy of the on-site handouts will be available for downloading within
    five (5) days of the program A paper copy of the handouts can be purchased at an additional cost of $25 The handouts can be purchased below

    Indicate which program you will be attending:
    Program                 Registration Deadline*
                                                                                                           Your name and credentials will be published on the program participant
           October 21-23, 2009                             September21 2009                                list distributed to all program attendees. Do you grant permission to
                                                                                                           CDR to include your business contact information along with your name
        November 9-11 2009                            October 12 2009                                      and credentials?
    *A $25 late fee will be added to all registration forms                                                       Yes
    submitted or postmarked after the posted deadline date

                                                                October 2009                                                          November 2009
 Payment Amount                                          Program Registration Fee ($345)              $________            Program Registration Fee ($345)                     $________

        •*Attend lunch on the second day                     On-Site Handouts ($25)                   $_________                   On-Site Handouts ($25)                      $_________

          of the program and have the                  Lunch-with-the Faculty (545)1*                 $_________             Lunch-with-the Faculty** ($35)                    $_________

           opportunity to ask specific                           Late Fee * ($25)                     $________                    Late Fee * ($25)                            $________

          questions of the faculty and            (include after published registration deadline.)                     (include after published registration deadline)
         network with other participants                      Total Payment Due                       $________                      Total Payment Due                         $________

 Method of Payment                                          Check/Money Order                  Visa/MC            Discover                 Mier Exp                Purchase Order Number
(Made payable to the Commission on D etetic Registration)                                                                                                          (Payment must be received
                                                                                                                                                                   prior to first day of program
Cancellation Policy If paying by credit card your name and signature below
indicate you agree t the amount being charged to your account and that the
registration fee is no refundable unless written request to CDR is postmarked 30 days First Name                         Lasi Name                                 Badge   Name (if different
prior to the first day of the program A $25 00 cancellation fee will apply if the pre-work
materals have been mailed In the rare nstance that you do not pass the pre-test a
refund will be provided m nus a $50 fee for the home study module                          Professional Credentials                      Posisson

Name on Card                                                                                    Federal-Express which does   fbi   deliver to   PU Boxes)

Card #                                 Exp ration Date

Signature                              Z p code of b fling address                              Telephone Number                                      Fax Number

If you have a disability that requires special accommodations, please indicate:                 E-mail address (Required for Registration Confirmation and oilier written communication.)
                                                                                                Business Name and Address ifnoi included above
         app cab        fl be ~niacted by COR far supplemental information)
(If applicable, you wi I be contacted by CDR for supplemental information.

Please provide us with your emergency contact information in Case we need to contact someone                           on your behalf while you are at the weight management program

Name                                                                                                 Day Time Telephone                                                             Evening Phone

To Register
I # Online wwwcdrnet.org                   I   Call 1400-877-1600 ext. 5500            I    Mail/fax form to:          Commission on Dietetic Registration
                                                                                                                       120 South Riverside Plaza, Suite 2000
                                                                                                                       Chicago, IL 606064995
#   Go to www.cdrnetorg to register on-line. Click on the certificate of training program                              Fax 1-312499-5364
link on the CDR homepage and choose the adult or childhood program.
 n event o canc nato o a certi ca o tr ining rogram any expenses incurred by registrants or prospective participants shall not be the responsibility o CDR
~Due to high convention center hote costs for lunch options for this program, the Lunch & Leam event fee for this program has ncreased from $35.00 to $45.00. The hotel is also
requiring that we have a minimum of 25 participants for this event. Therefore, if 25 participants do not register for the Lunch S Learn event by Friday, October 9, 2009, it wi I be cancelled.
All registrations for this event wit be cancelled with a full refund

Please see brochure for hotel Information.
‘This Certificate Program is only open to members of the American Dietetic Association, Registered Dietitians, and Dietetic Technicians, Registered.
J   I
        Certificate of Training in

                                                                                                               American Dietetic
                                                                                                         rig   Association

              Adult Weight                                                                                     8001577-1600 ext 5500

             October 2 1-23, 2009                      Hyatt Regency Denver Hotel
             Past FNCE 2009                       650 15th Street, Denver, CO 80202

             November 9-11, 2009      Melville Marriott Long Island
                            1350 Old Whitman Road, Melville, NY 11747

                 Visit the CDR website at www.cdrnet.org for additional program information

         Offered by the American Dietetic Association and Commission on Dietetic Registration.
                                      Approved for 28 CPE Hours—Level II
                               • • • • • • • • • • • •
         “This Certificate Program provides much needed and cuffing-edge knowledge and skills
              that will enable dietetics practitioners to capitalize on many new and exciting
                                    weight management career opportunities.”
                                 John Foreyt, PhD, Professor, Department of Medicine
                                 Baylor College of Medicine
                               • • . . • • • • • • • .
           Participation is limited. Please register by the registration deadline. (See registration form).
                 Past certifcate programs have been filled to capacity several days prior to the registration deadline.
                   CDR strongly recommends that flight arrangements and hotel reservations not be finalized until
                                            written registration confirmation is received.

        Hotel Reservations—A limited number of rooms have been reserved at the following hotels. To reserve your room
        at the special program rate noted below, please call the hotel by the registration deadline date and mention that you
         are attending the ADA Weight Management Workshop. You will need to guarantee your reservation with a major
                  credit card Payment of all room, tax and incidentals will be the responsibility of each individual.

                        Denver, Colorado—Hyatt Regency Denver Hotel, 650 15th Street, Denver, Colorado 80202
                                         Please visit the FNCE 2009 housing link at:
                          https //rms.ambassadors.com/index cfm2shc id2542&inblock=521 50
                                      to make your hotel reservation by September21, 2009.

                Melville, New York—Melville Marriott Long Island, 1350 Old Whitman Road, Melville, NY 11747
                              Rate $172 single/double for the evenings of November 8, 9, and 10
           To make your reservation, please call the Melville Marriott Long Island at 800/228-9290 by October 12,2009

                                        participants shall no be the ‘mv expenses incurred
               e en o cane Iation ofa certificate of training program.responsibilit~ ofCDR by regist ants or prospect te
                                                                            What’s Involved?
           Over half of American adults are overweight or obese.            There are three components to the certificate of
           A dietetics professional, trained to have a comprehen            training program:
           sive knowledge of the field and management options,              •    a self-study module (including 7-9 hours of
           can enable patient long-term compliance and sus                       readings, activities, and a pre-test)
           tained success.
                                                                                 the 2 1/2 day live workshop and
           This program is designed to produce providers of                 •    a take-home test.
           comprehensive weight management care who also
           know when and how to refer patients to other special             Since understanding the fundamentals of adult
           ists. It is open to ADA members, RDs, and DTRs.                  weight management is necessary to actively
           You should attend if you:                                        participate in the workshop, you must pass the
           •      currently counsel patients regarding their weight         pre-test (which is based on the self-study module)
                  and want to raise your practice level, or                 to attend the workshop. Those who do not obtain
                                                                            a passing score will be notified, and given an
           •      are switching careers to the area of weight               opportunity to retest as time permits.
                  management and need to hone your knowledge
                  and skills.                                               The workshop will focus on practical, interactive
                                                                            learning.    It will not repeat the didactic
                  The Certificate of Training offers:                       information covered in the self-study module.
           •      cutting edge information and skills shared by             After successful completion of the fUll course and
                  leading practitioners in the field                        the multiple-choice question post-test (taken at
                                                                            home after the course), participants will be
           •      cases and exercises to allow hands on experience          awarded a Certificate of Training in Adult Weight
           •      valuable resource materials and tools for                 Management,         suitable     for     framing.

.          •
                  immediate use and future reference
                  an opportunity to showcase your expertise by
                                                                            All program participants will receive continuing
                                                                            professional education units; however, only those
.                 earning a Certificate of Training
                                                                            who pass the post-test will receive the certificate.
                                                                            Participants will only be Liven one Opportunity to
                                                                            pass the post-test

             “We are positioned to take the lead in weight management Misinformation is rampant and we need to be
            practice to address the world-wide epidemic ofobesity. This cert(flcate program will provide the needed
            training and support to help us meet this sign (/lcant challenge.”
                     Sachiko St. Jeor, PhD, RD, FADA, Professor and Director
                     Nutrition Education and Research Program, University of Nevada School of Medicine

                 The expert faculty was wonderful. Ifelt confident that I was getting the most up-to-date accurate
               information available.”
                       Tammy B Darke, MS RD
                       Coto De Caza, CA

             “Terr(fic program! Very informative. Reinforced many concepts for me and helped me look at new areas,
            especially bariatric surgery in a d(fferent way. Thank you to a very professional, knowledgeable, teaching
                       Judith D 1-leesacker, MS RD CD
                       Ellensburg, WA

    To Register
    I # Online www.cdr.net.org       I   Call 1-800-877-1600 ext 5500   I   Mail/fax form to:   Commission on Dietetic Registration
                                                                                                120 South Riverside Plaza, Suite 2000
                                                                                                Chicago, IL 60606-6995
    # Go to www.cdmet.org to register on-line. Click on the certificate of training program     Fax 1-312499-5364

         Program Topics
         Current Research and Future Possibilities... Clinical Management of Overweight and
         Obesity... OTC Dietary Supplements... Behavior Modification... Application of Popular
         Diets and Weight Loss Programs... Formulas for Weight Loss... Medical Complications of
         Weight Loss... Role of Exercise... Pharmacotherapy... Bariatric Surgery as a Treatment
         Option... Case Studies
         *Please note that times are subject to change. A final agenda will be sent with the pre-work materials.

         Timeline (Tentative)

           October 2 1-23, 2009
           Wednesday                               Thursday                                 Friday
           8:00 am 6:00 pm                         8:30 am—6:00 pm                          8:30 am      1:00pm

           November 9-11, 2009
           Monday                                  Tuesday                                  Wednesday
           8:00 am—6:00 pm                         8:30 am      6:00 pm                     8:30am 1:00pm

.          (8:00 am check-in      8:30 am session begins)

.                                                                                                                  .

    Susan M. Cummings, MS, RD                                             Molly Gee, Med, RD
    Robert Kushner, MD                                                    Cathy Nonas, MS. RD, CDE
    Christina Biesemeier, MS, RD, ED, FADA                                Diana Radler, PhD, RD
    Ruth Ann Carpenter, MS, RD                                            Allison Schimmel Matson, MS, RD
    John Foreyt, PhD, Professor                                           Cynthia A. Thomson, PhD, RD
    Gary Foster, PhD

    *Program faculty to be selected from this list. Faculty vary by program.

    Advisory Committee
    A team of over thirty leading experts in the field of weight management contributed to the development
    and review of this certificate of training course, including George Blackburn, MD, Kathleen Cobb, MS,
    RD, CD-N, John Foreyt, PhD, Gary Foster, PhD, James Hill, PhD, Marsha Hudnall, MS, RD, CD,
    Laura Kettle Kahn, PhD, Robert Kushner, MD, Paul Larson, MD, Richard Mattes, MPH, PhD, RD,
    Cathy A. Nonas, MS, RD, CDE, Rebecca Reeves, DrPh, RD, FADA, Judith Stern, PhD, RD, Sachiko
    St. Jeor, PhD, MS, RD, FADA, Robert Wilson, DTR, and Babette Zemel, PhD.