Bluegrass District Dietetic Association

Your Link To Nutrition And Health

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BGDDA Membership

New in 2009...You can now register and pay online!  Simply fill out the registration form below and click submit.  Also, click "buy now" on the paypal button which applies to you to pay securely with a credit card ($1.50 convenience charge applies).  If you prefer the mail-in form, click on the link below to download the printable application.

If you are interested in joining the Bluegrass District of the Kentucky Dietetic Association, applications for the 2009-2010 membership term are due by August 14, 2009.
BGDDA Membership Application 2009-2010
2009-2010 Membership Application (Please complete form, submit and pay below using "buy now" button)
First Name
Last Name
Middle Initial
Preferred Mailing Location
Address Line 1
Address Line 2
City
State
Zip Code
Preferred Phone
Daytime Phone() -
Evening Phone() -
Pager
Fax() -
E-mail Address
ADA Number
Credentials
Position Title
Place of Employment
Please List any Dietetic Practice Groups to Which You Belong:
Membership Type (Active, Student or Retired)
Please indicate the year you joined ADA as a member, and if associate or active.
Please indicate your age as <35, 35 or >35 (helps to determine award qualifications)
Would you like your contact information to be included as part of a mailing list released to other professional organizations?
Would you be willng to have your contact information released to legislators who wish to advise you on their stand on nutrition issues?
Would you be willing to have your name listed on the Speaker's Bureau? If so, on which topics would you be willing to speak?
Please list any positions/committes that you are willing to serve this year for BGDDA and/or KDA (Options: Awards/Honors, By-Laws, Career Guidance, Continuing Education, Council on Professional Issues, February Seminar, Job Coordinator, Historian, National Nutrition Month, Legislation, Marketing/PR, Nutrition Information, NSPS, Membership, Quality Assurance, Registrar, September Dinner Meeting, Web Page)
Please indicate which elected positions for which you might be interested next year on the district, state or national level (Options: President-Elect, Secretary, Treasurer, Nominating Committee, State Delegate)
Please list any topics that you would like discussed at the CEU meetings for next year
Active Membership (New or Renewal)
$26.50
Student Membership
$11.50
Retired Membership
$16.50