Page Title Here
Membership Application
To join our association simply fill out the form below and click submit.
Then follow the instructions to complete your payment online.
Thank you for your interest!
Your name:
Credentials:
ADA Member Registration #:
Address:
City:
State:
Zip:
Phone:
Work:
Home:
Cell:
e-mail address:
(Preferred)
Area of Practice:
Community/Public Health
Consulting Dietitian
Education
Self Employed
Clinical-Inpatient
Food Service
Clinical-Outpatient
Other:
May we publish your personal and work contact
information in the directory?
Yes
No
Preferred Meeting Time, Day, and/or Place
Please check the committees/activities in which you are interested:
Fundraising
National Nutrition Month
After submitting the form return to this
page and click the link below to complete
payment of your dues.
Select One
Active ADA Member $20.00
Student ADA Member $5.00
L
ubbock
A
cademy of
N
utrition &
D
ietetics
