SADA Logo San Antonio Dietetic Association
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San Antonio Dietetic Association
Membership Application for 2007 - 2008

Membership year runs from June 1, 2007 to May 31, 2008 (dues are not prorated).

Use this form to apply directly to SADA. When you click Submit, we will be emailed notifying us of your application. To update your information please type your name and then any areas that need to be changed.

Last Name
First Name
Email
Credentials
ADA #
Licensure
Title
Office Location
Work Address
Work City
State
Zip Code
Work Phone
Work Fax
Pager
Home Address
Home City
State
Zip Code
Home Phone
Home Fax
Home Information Restricted?
 Yes No
Willing to speak for groups?
 Yes No
Topics
Bilingual?
 Yes No
Area of Expertise
Willing to be a volunteer?
 Yes  No
If "Yes", please select the areas in which you would like to help:
All Areas
Association Events:
Greeter
Christmas Party
Spring Seminar
Planning
Scholarships
Legislative Events:
PAC Fundraising
Day at the Capitol
Public Relations Events:
Health Fairs
San Antonio Fit City Initiatives
Other
List any ADA Dietetic Practice Groups that you are a member of...
List any other associations that you are a member of or hold a position in?
Select all that you apply to:
  
Medicare
Medicaid
Private Insurance
Do you plan on becoming a Medicare provider?
 Yes No
Membership Categories:
Active Member
- $25
Diet Technician
- $20
Student (Full- Time) - $15
Retired
- No Fee
Select Membership Type
Note: Add $5.00 to membership fee if you would like a printed member directory mailed to you.
SADA Scholarship

Make a separate check out to: SADA

Put Scholarship in memo field.

TDA Legislative Fund

Make a separate check out to: TDA Legislative Fund

This is used for travel expenses, copying, mailing, training for legislative efforts. This is separate from that which goes to legislators.

TDA PAC Fund Contribution

Make a separate check out to: TDA PAC

These funds are used to support TDA in maintaining and promoting our positions in the legislative system, for travel of expert witnesses (RDs) giving testimony, and for legislative related copying and mailing.
Total Enclosed
 $

All dues are payable by May 31st.

Please allow 4-6 weeks for the processing of your application. Processing will begin upon receipt of your dues payment.

Mail your payment to:

SADA
PO Box 6492
San Antonio, TX 78209
   
 

 
 
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