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Yes! I am an Academy member and would like to become a MEMBER of Diabetes Care and Education. Enclosed is my annual membership fee of $30.00 for the 2011 - 12 year.
Academy Member Number: __________________________________________ Name: _______________________________________________________ Title: _________________________________________________________ Company: ____________________________________________________ Address: ______________________________________________________ City: _____________________ State/Zip: ___________________________ Phone: ___________________ Fax: ________________________________ E-mail: _______________________________________________________
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- Please make check or money order payable to: Academy/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