Mediterranean Diet Form for Dietitians | UConn School of Pharmacy

Dietitian Mediterranean Diet Registration Form

Use this form if you are registering for the Mediterranean Diet CE if you are NOT a pharmacist but ARE a Dietitian.

Name(Required)

Email(Required)

Phone(Required)

Member # (Dietitians)/NABP ID (pharmacists & techs)(Required)

Company/Organization(Required)

City

State(Required)

Please let us know if you require special services due to a disability or food allergy/intolerance

Early Bird Registration (before August 15, 2022): $850 Registration (August 15, 2022-November 1, 2022): $950 Please email Joanne Nault to make payment with Credit Card @ joanne.nault@uconn.edu or call 860-486-2084 You can send a check to: UConn School of Pharmacy-Attn: Joanne Nault 69 N. Eagleville Road Unit 3092 Storrs, CT 06269 The conference is limited to 50 attendees and 25 guests. Space will be filled on a first, come first serve basis after payment.

Name

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