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Membership Type *	2011-2012 Active Membership Dietetic Technician, Registered ($25.00 for period up to 05/31/2012) 2011-2012 Active Membership Registered Dietitian ($27.00 for period up to 05/31/2012) 2011-2012 Student Membership ($7.00 for period up to 05/31/2012)
Students must be enrolled in a program for the academic year-verification from a Program Director must be provided in order to accept a student application. PayPal will add a $2.00 charge to your membership amount for processing Please Consider making a donation to PADA PAC and/or PADAF (scholarship fund). Please write separate check for PADA PAC and PADA each.
Payment System *	PayPal secure credit card payment
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ADA Member ID *
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Membership Status *	Returning member New Member
Employment Position (Title)
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Check any activity ( Check any activity in which you are interested )	Run for office. Any particular office Legislative Activities Mentor for a student to share about your career and work Membership activities Would you like to be mentored by an RD for the year to gain insight into careers opportunities. Public Relations/National Nutrition Month Program Planning (Council on Practice)
Award Nominations ( For possible award nominations, check that which applies to you )	Under 35 Over 35 and have been an RD for less than 10 years
Topics of membership meetings (Please give us two topics on which you would like to see membership meetings)
Should the programs be	Half day Whole Day Evenings
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Want to Member speakers bureau? * Would you be willing to be a member of a speakers bureau for specific topics?	Yes No