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Vegetarian Nutrition DPG Student Membership Application

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Vegetarian Nutrition DPG Student Membership Application Powered By Docstoc
					        Our mission is to serve as the leading authority on evidence-based vegetarian nutrition for health professionals and the public.



            Vegetarian Nutrition DPG Student Membership Application
              $10 Discounted Rate                  New Membership Rate Effective: November 1, 2007

*ADA ID Number: ____________ *First Name: ______________ *Last Name: _______________________
Mailing Address: __________________________________ City, State Zip: ___________________________
*E-mail Address: ________________________________ *Phone Number: ___________________________                     The Vegetarian Nutrition Dietetic Practice
*Required                                                                                                        Group (VN) is pleased to announce its new
                                                                                                                         student membership rate.
                           ADA’S MEMBERSHIP YEAR IS JUNE 1- MAY 31,
 Applications received after February 29, 2008, will be processed for the next membership year (June 2008-May   Student members are important to the growth
 2009) unless specifically requested. ADA and DPG dues are not prorated, refundable or transferable.            of the ADA and the DPGs. Our new student
                                                                                                                member program will include a Student
In order to take advantage of this program, you must be an ADA student member. The VN Student Member            Corner in the newsletter and a student member
Discount is ONLY available by mailing/faxing this application or by phoning ADA Membership at the               page on our website.
number listed below. Information on ADA membership can be found at www.eatright.org
                                                                                                                A reduced fee does not mean reduced benefits!
BEGIN MY VN DPG STUDENT MEMBERSHIP:
                                                                                                                  ♦     Quarterly newsletter
     As soon as possible (June 2007-May 2008)
                                                                                                                  ♦     Access to the online listserv
     HOLD for the June 2008-May 2009 membership year. 2008-2009 ADA student membership dues
                                                                                                                  ♦ Access to the members’ only section of
      must be paid in order to participate.
                                                                                                                      the website, which provides current
    AMOUNT DUE TO VN DPG: $10.00                                Student Discount: USE CODE: VNST                      updates, materials, and resources.
                                                                                                                  ♦ Reduced rates on VN workshops and
  PLEASE MAKE CHECKS PAYABLE TO: VN-DPG #14 – ADA                                                                     FNCE events
                                                     -OR-                                                         To learn more about VN DPG please visit
                   American Express        Discover             MasterCard         VISA                              www.vegetariannutrition.net


    Credit Card Number: __________________________________ Exp. Date (mo/yr) ___________

    Signature: ______________________________ Daytime Phone Number: __________________
                 ** When paying by credit card you may also fax your application to 312-899-4812
                                  or apply by phone at 1-800-877-1600, ext. 5000


                                                                                                                         Mail to:
                                                                                                                         American Dietetic Association
                                                                                                                         Attention: Membership Team
                                                                                                                         120 S. Riverside Plaza, Suite 2000
                                                                                                                         Chicago, IL 60606-6995