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This document is a change of name and/or address form for the American Dietetic Association/Commission on Dietetic Registration. It requests the member's identification number, name, address, phone numbers, email addresses, state affiliation, effective date, and signature. Legal documentation is required for any name changes. The form should be mailed or faxed to the ADA/CDR offices in Chicago, Illinois.
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All info about Diabetes and how to control it.
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
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Legal Documentation
- 1. AMERICAN DIETETIC ASSOCIATION/COMMISSION ON DIETETIC REGISTRATION CHANGE OF NAME AND/OR ADDRESS FORM Complete this form to notify ADA/CDR of a name* and/or address change. PLEASE PRINT all the information requested and include your membership/registration ID number. Allow three (3) weeks for processing changes. IDENTIFICATION NUMBER FIRST NAME MI LAST NAME* MAIDEN/PREVIOUS NAME* (Circle one) NEW ADDRESS (Line 1) NEW ADDRESS (Line 2) NEW ADDRESS (Line 3) - CITY STATE ZIP/POSTAL CODE COUNTRY Note: Individuals with non-U.S. or U.S. Territory addresses, please be specific when documenting your address. For example if yu “ot cd” hu b lt if no yu cy a ehnnl etprpie it cy id Iyu ae usos orps loe sol eie n r t f ori nm t i u iapor tynh i f l f o hv qet n a d sd o t e cd al e t e. i please feel free to e-mail the Member Service Center membrshp@eatright.org. WORK PHONE HOME PHONE WORK FAX HOME FAX WORK E-MAIL ADDRESS HOME E-MAIL ADDRESS PREFERRED STATE AFFILIATION (If no selection is made, you will be assigned to the state corresponding to the address of record.) EFFECTIVE DATE SIGNATURE FORMER NAME/ ADDRESS (If available affix mailing label from Journal) Mail to: American Dietetic Association OR Fax to: 312/899-4772 Commission on Dietetic Registration 120 South Riverside Plaza, Suite 2000 Chicago IL 60606-6995 06/07 * Legal documentation must accompany all name changes (i.e., divorce decree/court order; marriage license/certificate; social security card –reflecting new name; state ID/drivers licensure –reflecting new name)