Knoxville District Dietetic Association

If no change in information from previous year, please check here.  No Change

CURRENT CONTACT INFORMATION

Last Name:

First Name:

Middle Initial: Select OneABCDEFGHIJKLMNOPQRSTUVWXYZ

Check all that apply:  PhD MS MA MPH RD LDN DTR Other

If Other:

RD#:

Home Address:

P.O. Box/Apt #

City:

State: Select OneAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

ZIP Code:

Home Phone:

Email:

Place of Employment:

Title:

Work Address:

P.O. Box/Apt #

City:

State: Select OneAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

ZIP Code:

Work Phone:

Cell Phone:

MEMBERSHIP INFORMATION

Please check the type of membership that best describes you.

ADA Members:  R.D. Associate DTR Retired Other |  Student

If you are an ADA Member, please indicate Membership #:

MEMBERSHIP DUES

 ADA/KDDA members (including students who are currently RDs) - $20.00
 Retired members - $10.00
 Students - $10.00
 To have paper copy of directory mailed to you - $8.00

Total Amount Due:

KDDA is going GREEN. Directories will now be E-Mailed.
Directories will not be mailed unless $8.00 for shipping is included.
KDDA is an affiliate of TDA and ADA. Due to policy change, KDDA members must now be ADA members.

VOLUNTEER OPPORTUNITIES

UNSA/KDDA Student Mentoring Network

 I am a RD and am interested in learning more about serving as a mentor for undergraduate nutrition students. Please forward my information to Melissa Hansen-Petrik, PhD, MS, RD, LDN.

 I am an undergraduate student and am interested in learning more about being mentored by local RDs. Please forward my information to Melissa Hansen-Petrik, PhD, MS, RD, LDN.

Nominating Committee

The nominating committee would like your help with nominations for the 2011-2012 KDDA Officer Ballot. Please write in your nomination for the officer positions (including self-nominations). Nominees will be contacted to discuss the position (or other officer positions) prior to being placed on the ballot.

President-Elect:

Secretary (two year term):

Nominating Committee:

CPI- Chair Elect:

 I would like the nominating committee to contact me to discuss officer positions. All nominees will be considered by the committee but not guaranteed to be placed on the ballot.

Please contact Heather Pierce, MS, RD, LDN, KDDA Nominating Committee Chair, with any questions hpierce@bmnet.com.