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Member Registration

Notes:

The GMDI membership year begins on January 1st and ends on December 31st of the current year.
GMDI accepts payment by check (made payable to "GMDI") or by credit card (Visa, MasterCard, or American Express via PayPal).

* Required in order to process your application

*First Name
Middle Name
*Last Name
*Job Title [Metabolic Dietitian, Clinical Dietitian etc.]
Credentials [MS, PhD etc.]
*Work Address
*City
*State
*Zip / Postcode
*Country
*Work Phone
Work Fax
*Email Address
*Confirm Email Address

*Membership Type

	Full Membership ($100)
	Emeritus Membership ($50)
	Associate Membership ($50)

*Registration / License Number

Upload Registration /
License Document

I will Fax to (404) 778-8562 or Mail to info@GMDI.org my current professional license / registration document along with a copy of registration confirmation e-mail from GMDI.

Area of Expertise
Research Interests
Clinical Interests

To help GMDI grow as a vital organization and to help GMDI meet your professional needs, please provide the following information.

I have interest in supporting GMDI through committee membership of:	Communications Team- newsletter, conferences, surveys Executive Committee- officers, guiding and directing the organization Education and Training Committee- develop training and clinical protocols Membership and Nominating Committee- support encourage membership, nominate Borad candidates
I am willing to have GMDI use my name and address to promote the organization Yes No I am interested in being a mentor for dietitians new to the practice of metabolic nutrition YesNo I would like to receive newsletter from GMDIYes No

Preferred Payment Option:	by Check Online by Credit Card In case of Credit Card, enter the Name on the Card below.
Next Step: Membership Payment. Please keep your Credit Card OR Check details ready before clicking ‘Submit’. Please DO NOT refresh Payment page.

GMDI prefers Online Registration.
But if you wish to register by Fax, Email or Post, please Download the Registration Form here and send it along with your current professional license / registration document.

Send to:	Rosalynn Borlaza, Program Coordinator Genetic Metabolic Dietitians International
Fax:	(404) 778-8562
Email:	info@gmdi.org
Address:	GMDI P.O. Box 2964 Decatur, GA 30031-2964