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: _______________________________________________________

  • Please make check or money order payable to: Academy/DCE DPG 23
  • For credit card payments, fill out the following:
MasterCard/Visa#: _____________________ Expiration Date: ______________

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

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