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NENYDE 2010 Membership Application
May 18, 2010 - 6:18PM
North Eastern New York Diabetes Educators (NENYDE) Membership Application
NENYDE IS COMPRISED OF HEALTHCARE PROFESSIONALS WHO ARE INVOLVED IN THE DEVELOPMENT, DELIVERY OR ADMINISTRATION OF THE DIABETES PATIENT OR PROFESSIONAL EDUCATION. NENYDE IS DEDICATED TO ADVANCING THE ROLE OF THE DIABETES EDUCATOR AND IMPROVING THE QUALITY OF DIABETES EDUCATION AND CARE IN NORTHEASTERN NEW YORK.
Member benefits include:
• Educational programs featuring nationally known speakers
• All programs at reduced rates
• Networking opportunities with local Diabetes Educators
• Social events such as the Annual Holiday Gala and instillation dinner
• Membership meetings held three times a year in convenient locations throughout the Capital District
PLEASE ANSWER ALL QUESTIONS.
Select your type of membership:
□ I have an AADE membership and want to be an active voting member of
NENYDE and be eligible for office. Please enter your AADE member #: $20.00
□ I am NOT an AADE member and want to be an active voting member of
NENYDE. This also includes receiving program and meeting notices. $40.00
□ I am a student and wish to be a member of NENYDE. $10.00
□ I am a Pharmaceutical Representative and wish to be a member of NENYDE. $50.00
Check all that you are, or might be, interested in:
□ Serving as a committee chair person
□ Presenting or organizing an educational program
□ Assisting at events or activities
□ Legislative activities
□ Serving on the board
□ Future leadership positions in NENYDE
LIST ALL INFORMATION AS YOU WOULD LIKE IT TO APPEAR ON THE MEMBERSHIP LIST:
Name Credentials
Title Place of Employment
Mailing Address
Phone (incl area code): Work: Home Cell
Fax E-Mail address*
*Please note that all correspondence throughout the year is via email. Please print clearly!
Please check if you agree with the following statement:
□ I agree to have my membership information published on the NENYDE web site. I understand that this
information is for members only and is password protected.
Mail the completed application with your check to:
NENYDE
PO Box 3901
Albany, NY 12203-3901 Thank you!
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