DAFP Partnering to Prevent Diabetes - 10/13/14 - Registration

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* 1. First Name:

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* 2. Last Name:

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* 3. Degree or Designation (MD, DO, etc if applicable):

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* 4. Email Address:

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* 5. Phone Number:

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* 6. Entree Choice (please select):
Note: All entrees served with Arugula Salad with Tossed Greens and Balsamic Vinaigrette

Roasted Butternut Squash with Spinach and Tomatoes over Orechetti Pasta with Olive Oil

Stuffed Chicken with Sundried Tomatoes, Roasted Peppers and Spinach with a Ricotta Cheese

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* 7. Dessert Choice:

Fresh Fruit Plate

Triple Chocolate Mousse Cake

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* 8. Please specify any dietary restrictions: