Florida Academy of Nutrition and Dietetics - Florida Academy of Nutrition and Dietetics

Florida Legislative Day Stipend Application Form

()First Name: Please enter your first name. Middle Initial: () Last Name: Please enter your last name.
(*) AND Number: Please enter your ADA member number.
(*) Address Line 1: Please enter your address.
Address Line 2:
() City: Please enter the city. ()State: must contain only A-Z characters (*)Zip Code: Please enter your Zip code. +4:
() Email: Please enter a valid e-mail address. ()Telephone: Please enter a contact number.
()I am applying for the following stipend: Florida Legislative Day Stipend*
(*) Event Start Date: Please select an event start date.		(*) Event End Date: Please select an event end date.
(*) Cost to attend; include proposed expenses: Please enter a numeric amount.
Have you ever attended this event before?Invalid Input
(*) Why is public policy important to the future of dietetics? Please answer this question.
(*) List at least three (3) objectives for participating in this experience: Please explain.
(*) Explain how this opportunity with our legislators and public policy will enhance your dietetic career: Please explain.
() AND member since (year): Please enter the year. (year) () Number of years lived in Florida: Please select.
() Member of FAND since (year): Please enter value. (year) () Member of District: Please select your member district.(*)Since: Please enter a year. (year)