2016-2017 BRAND Membership Form
Please fill out the online membership form below and submit. Annual membership dues may be paid via PayPal by scrolling to the bottom of the page and adding appropriate member category into the cart for checkout. Receipt is emailed through PayPal immediately after payment.

If you would like to pay by check and send in a papercopy membership form, please make checks payable to "BRAND" and mail check with completed form to Vanessa Richard, RD, LDN at the address listed below. Paper membership form can downloaded below the online form.

Vanessa Richard, RD, LDN
17628 Shady Elm Avenue
Baton Rouge, LA 70816

For further assistance with the online form, please contact us at eatrightbr@gmail.com.

Full Name: *
Your answer
Credenitals: *
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Place of Employment and/or Specialty Area: *
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Preferred Email Address: *
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Preferred Telephone Number: *
Your answer
Are you a member of the Academy of Nutrition and Dietetics? *
Please select from the options below: *
As we move toward an electronic system, may we use your email address for all communication? *
Would you be willing to be a member of the BRAND Speaker's Bureau? *
Please indicate your time preference for BRAND meetings:
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Noon
Afternoon
Evening
Anytime
Please indicate your weekday preference for BRAND meetings:
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Monday
Tuesday
Wednesday
Thursday
Friday
Would you be willing to host a meeting at your work location? *
How can BRAND support you as a dietetic professional? Please indicate all that apply. *
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So that we can plan programs to meet member needs, please indicate all the learning needs on your personal Professional Development Portfolio.
Please indicate the committees that you would like to participate in (select all that apply):
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