Professional Membership form

Professional Membership Form
$30

Choose Any *

New application Renewal

* Indicates required field

Name *

First

Last

Credentials (if any, or N/A) *

Preferred Name *

Address *

City *

Zip code *

Phone Number *

Email *

Instagram Handle (optional) *

Facebook Username (optional) *

Current job position(s) and location(s) *

I am willing to include my personal information in a TAND directory so that fellow members can contact me. (Information will be shared ONLY with fellow TAND/VAND members). *

Yes No

AND membership number (AND membership is required to be a member of TAND) *

Please upload a copy of you AND card (NOT YOUR CDR CARD) *

Max file size: 20MB

Are you a VAND member? *

Yes No

Do you currently serve as a preceptor for dietetic students? *

Yes No

If not, would you be willing/able to serve as a preceptor in the upcoming year?Choose One *

Yes No N/A

Other, please specify *

***Please don't forget to pay your due online by clicking on the Paypal button

Submit

Professional Membership Form ​$30

Professional Membership Form
$30