Mediterranean Diet Form for Dietitians 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.NameThis field is for validation purposes and should be left unchanged.