| Yes!
I would like to become a MEMBER of Diabetes Care and Education. Enclosed
is my annual membership fee of $30.00 for the 2009 - 10
year.
ADA Member Number: __________________________________________ Name: _______________________________________________________ Title: _________________________________________________________ Company: ____________________________________________________ Address: ______________________________________________________ City: _____________________ State/Zip: ___________________________ Phone: ___________________ Fax: ________________________________ e-mail: _______________________________________________________ |
- Please make check or money order payable to: ADA/DCE DPG 23
- For credit card payments, fill out the following:
Signature: ____________________________ Billing Zip Code: _____________
Mail to:
The American
Dietetic Association
P.O. Box 97215
Chicago, IL
60607
Payments or contributions are not deductible as charitable contributions for Federal income tax purposes. Payments may be deductible as a business expense. If in doubt, please consult your tax advisor.
For accounting only: 132-210-2210