CIAND Membership Form | Indiana Academy of Nutrition & Dietetics

Member Information

Date

Name:*

First Middle Initial Last Credentials

Address:*

Street Address Address Line 2 City State ZIP Code

Primary Phone:*

Work Phone:

Email:*

Place of Employment:*

Registration Status

CIAND uses the Internet to distribute information on job openings, legislation, meetings and other items of interest. CIAND DOES NOT share or distribute our e-mail with any organization. If you wish to not be listed please let us know via e-mail.

Please publish my e-mail address in the CIAND membership directory.*

Yes

Please include my e-mail address on the CIAND Google distribution list used to communicate upcoming events and information to CIAND members.*

Yes

Academy Membership Number:*

Registration Status & Dues*

Practice Key Area

Clinical

Management

25. Computer / Informatics

26. Foodservice Management

27. Management

28. Healthcare Administration

29. Multi-Department Management

30. Multi-Facility Management

31. Organization Development

32. Retail Merchandising

33. Sales / Marketing

Education

34. Educator, dietetics students

35. Education, Other

Education, Other -- Please Specify:*

Community Wellness

36. Cooking

37. Classes/Demos/Grocery Tours

38. Public Health/Community

39. Nutrition Communication

40. Sports Nutrition Wellness

Other: 41. Practice Specific, Care -- Please Specify:

Please list any continuing education interests that you would like to have fulfilled to help CIAND with future program planning:

I would like to serve on the following committees:

CPI – assist the CPI with planning, implementing, completing Educational meetings (6-7 meetings / year)

National Nutrition Month – assist the NNM chair with planning / implementing NNM activities

Newsletter Assistance – write / contribute pictures / articles to the Newsletter There are 4 newsletters / year

Public speaking / Media – volunteer with television / radio requests / CIAND speaker bureau

Public Relations / Legislative Representative

Payment

Dues payment is optional for all members for the 2024-2025 membership year. If desired, please send a Zelle payment of $37 to ciandtreas@gmail.com. Contact Justine Carr at ciandtreas@gmail.com with questions or concerns regarding dues.

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