Oregon Academy Auxiliary Membership Application

Thank you for your application to be an Auxiliary Member of the Oregon Academy of Nutrition and Dietetics.
Please complete this form and submit.
We'll will be in touch within 5 business days.

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* 1. Please indicate which type of membership you are applying for.

Individual membership

Corporate membership

Not-for-profit organization membership

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* 2. Please add your company's info here.

Your name:

Company:

Address:

Address 2:

City/Town:

State:

ZIP:

Website:

Email Address:

Phone Number:

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* 3. Please describe your company and it's products and/or services.

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* 4. Please add information on why your company would like to have auxiliary membership.

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* 5. For individuals, please provide the following info:

I am currently a national Academy member residing in another state and would like to have dual state membership.

I am a Registered Dietitian but am not a national Academy member.

I am a Dietetic Technician Registered but am not a national Academy member.

I am an interested individual and would like to support the work of the Oregon Academy.

Other (please specify)