Florida Academy

of Nutrition and Dietetics

2017 Symposium Super Early Bird Registration Form

FAND Annual Symposium, July 15-18, 2017
Fort Lauderdale Marriott Harbor Beach Resort & Spa, Fort Lauderdale, Florida

Fields marked with an asterisk ( * ) are required.

Nick Name (your first name as you wish it to appear on your name badge):
Email: (*) is not a valid e-mail address.
Last Name: (*) Please enter your last name. First: (*) Please enter your first name. Middle Initial: Credentials:
AND Member #: FL License #: Daytime Phone: (*) Please enter a phone number.
Place of Employment/School: Position/Title:
Employment Address: City: State: Zip: is not a ZIP Code.
Home Address: City: State: must contain only a-z,A-Z characters Zip: Please enter a valid ZIP code.

  1. Super Early Bird Registration:
    Accepted ONLY if submitted on or before February 28th, 2017.

    AND Members and Guests Only

  2. AND Members
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  3. Guest*
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  4. Guest One Day or Full Meeting
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  5. *Note about guests:

    A guest cannot hold a degree in a nutrition-related field, i.e. can be family member or friend. Guests are welcome to attend the receptions and nutrition breaks, but due to limited seating they cannot attend the breakfast or lunch sessions.
  6. Check all that apply
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  9. Special Events - Sunday, July 15, 2017
    (NOTE: Special Events on Sunday have extra fees)

  10. Ethics
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  11. Medical Errors
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  12. Integrative and Functional Nutrition Pre Convention Workshop
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  13. I would like to add $5 or more for Scholarship:

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  14. Other Events - Check to be Issued a Ticket for Admission

  15. Please Note: In order to receive a ticket for the Annual Member Empowerment Breakfast, you must call 850.386.8850 with your credit card information, which will be charged $25.00 ONLY if you do not attend the breakfast (Members Only).
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  20. If registering on behalf of someone else, or if you have guests, please list their names here:
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  21. When you click the Register button below you will be directed to PayPal to complete your purchase.

  22. Registration Total:
    0.00 USD

Florida Academy of Nutrition and Dietetics

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