FDA Annual Symposium 2008: Registration

Name:
      Prefix:
    * First:     * Last:     * Prof. Credentials:
Nick name (your first name as you wish it to appear on your name badge):
Home address:
    * Line 1:
      Line 2:
    * City:
    * State:       Zip code:
         Country:
* E-mail Address:
       Daytime
   Phone:
* Place of Employment
    or School:
    * Title/Position:
  ADA Membership #:


* required items
       License #:


Registration Fees
Early Bird (available through June 2)
      Full
Meeting		   One
  Day *
ADA member $230 $130
FDA Subscriber $350 $200
Non-ADA member $460 $260
Retired ADA member $50 $30
Student ** $50 $30
Guest *** $75 $60
* If attending only one day, select day:
    Sunday
    Monday
    Tuesday

** Must furnish documentation on letterhead of student status in a CADE accredited program.

*** Cannot hold a degree in a nutrition-related field, i.e. family member or friend.

Regular Registration Fees
(after June 2)
  Full
Meeting		 One
Day *
ADA member $280 $150
FDA Subscriber $400 $220
Non-ADA member $560 $300
Retired ADA member $95 $45
Student ** $100 $50
Guest *** $125 $80
   
Special Events

Saturday		 Early Bird     Regular
(after June 2)

Medical Errors
  Member		 $30       $50
  FDA Subscriber $45       $65
  Non-Member $60     $100
  cancel Medical Errors        

Nutrition Care Process
  Member		 $45       $65
  FDA Subscriber $70       $90
  Non-Member $90     $130
  cancel Nutrition Care        

Cracking the Code
  Member		 $15       $35
  FDA Subscriber $25       $45
  Non-Member $30       $70
  cancel Cracking the Code

I would like to add $ for scholarship (minimum $5)
    Registration total:    
    Special Events total:    
    Total fee:    


I plan to attend Breakfast with the Experts *
(MEMBERS ONLY)

I plan to attend the Members Reception
      Monday evening *
* These events are complimentary, but in order to estimate attendance, admission will be by ticket only. Please check the box to receive your ticket.

REFUND POLICY

Requests for refunds must be postmarked on or before June 16, 2008. Registrations will be refunded less a $35.00 processing fee.

NO REFUNDS AFTER June 16, 2008


Click the Submit button to review your selections before making your payment at PayPal.com.

Florida Dietetic Association
P. O. Box 12608
Tallahassee, FL 32317-2608
FAX (850) 386-7918     Phone (850) 386-8850