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FDA ANNUAL SYMPOSIUM July 12 - 15 , 2009 · Naples Grande Beach Resort, Naples, FL
 
Nick Name
   
E-mail
  
First Name
    
Last Name / Credentials
  
Initial
    
ADA Member#
  
Daytime Phone
    
Florida License#
  
Position/Title
    
Place Employment / School
  
Employment Address
    
City
  
State
    
Zip
  
Home Address
 
 
EARLY BIRD REGISTRATION FEES

 
 

REGULAR REGISTRATION FEES POSTMARKED OR RECEIVED AFTER (af)
JUNE 1, 2009

 
Full Meeting
One Day*
ADA Member

$285

 $155
FDA Subscriber $405 $225
Non-ADA Member $570 $310
Retired ADA Member $95 $45
Student** $100 $50
Guest ** $125 $80
     

* If attending only one day, circle which day:

Monday
Tuesday
Wednesday

** 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.
 
SPECIAL EVENTS
 
Sunday  
     
Medical Errors
  Member $60
  FDA Subscriber $75
  Non-Member $120
Feeding Florida's Children
  Member $50
  FDA Subscriber $65
  Non-Member $100
   
I would like to add $5 for Scholarship
   
REGISTRATION
SPECIAL EVENTS
SCHOLARSHIP
TOTAL ENCLOSED
   
I plan to attend the annual Business Meeting *
** In order to receive a ticket, we must have your credit card information, which will be charged $25.00 ONLY if you do not attend the breakfast (MEMBERS ONLY)
 

I plan to attend the Members' Reception Tuesday night*

*Both of 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

Request for refunds must be postmarked on or before June 15, 2009. Registrations will be refunded less a $35.00 processing fee.

NO REFUNDS AFTER June 15, 2009
 
METHOD OF PAYMENT

 
Credit Card

 


Mailing Address:
Florida Dietetic Association
P.O. Box 12608
Tallahassee. FL 32317-2608
FAX (850) 386-7918 · PHONE (850) 386-8850

info@eatrightflorida.org

 
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