Join NowMembership ApplicationIf you are human, leave this field blank.Membership Application for July 1, 2023 - June 30, 2024Membership Levels:Active: $50 (until Aug 1) / $60 (after Aug 1)Student: $30Retired: $30Type of membership application: *New MemberReturning MemberAre you a registered dietitian or a student? *RD/RDN/LD/DTRStudentIf you are a student, what university do you attend?Texas State UniversityUniversity of TexasName *Address *CountryUnited States (US)United Kingdom (UK)CanadaAustralia---AfghanistanÅland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAmerican SamoaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelauBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos 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IndustryCommunication/PublicationCommunity NutritionConsultation/Private PracticeClinical Nutrition (General)CulinaryDiabetes CareEducationFood & Nutrition ManagementHunger/Environmental NutritionIntegrative/Functional NutritionLong/Term CareGerontologyOncologyPediatricPolicy & AdvocacyNutrition SupportResearchSchool NutritionSports NutrtionVegetarian NutritionWeight ManagementWellness/PreventionOtherYour name, employer, job title and area of practice information will be used in our member directory, your personal contact information will not be used.Demographics: Do you identify as Multiracial or more than one Race/Ethnicity?YesNoDemographics: Race/Ethnicity (check all that apply)American Indian/Alaskan NativeNative Hawaiian or Other Pacific IslanderHispanic/Latinx Black or African-AmericanWhiteMiddle Eastern East Asian (including Chinese, Japanese, Korean, and Mongolian)South Asian (including Bangladeshi, Bhutanese, Indian, Nepali, Pakistani, and Sri Lankan)Southeast Asian (including Burmese, Cambodian, Filipino, Hmong, Indonesian, Laotian, Malaysian, Mien, Singaporean, Thai, and Vietnamese)My Race/Ethnicity is not listedNot disclosedWould you like to volunteer with Dietitians of Central Texas?YesNoWhat part of Austin/Central Texas is best for you when meeting in person?South AustinNorth AustinCentral AustinEast AustinWest AustinRound RockCedar ParkPflugervilleBudaDel ValleManorWest LakeAs we transition to in-person meetings, would you recommend any places in Austin or surrounding areas that can host 50+ people for our members meetings? (Please leave any other comments related to preferred meeting locations here.)Instagram HandlePHOTO/VIDEO RELEASE FORM (enter Full Name) *I, ______________________________________________ , consent to the unrestricted use, by Dietitians of Central Texas (DCTX) (and those acting with its permission and authority), of any and all media taken, in whole or in part, unlimited use, for all purposes in any form or medium, including, without limitation, its use through or on any electronic media, including the Internet. I waive any right to inspect or approve the finished product or products or the advertising copy or printed matter that may be used with the finished media. Further, I relinquish all rights, titles and interest I may have in the finished media, negative(s) and reproduction to any responsible business firm or publication. It is understood that Dietitians of Central Texas (DCTX) retains copyright of media at all times under the express understanding and agreement that Dietitians of Central Texas (DCTX) shall have exclusive reproduction rights to the media. I hereby release Dietitians of Central Texas (DCTX) from any and all claims in connection with the media, including any and all claims of libel.PHOTO/VIDEO RELEASE FORM (age confirmation) *I am over the age of 18. I have read the above and fully understand its contents.PHOTO/VIDEO RELEASE FORM (Name, Address, Phone) *By checking this box, I confirm my name, address and phone number in the membership form above are true and correct to use for the purposes of the Photo/Video Release formSubmit Registration FormAfter submitting this form, you will be redirected to the membership payment page. *Please note that your membership will NOT be active until you select your membership level on the following page and complete your payment.* Terms and Conditions *I agree to the Terms and ConditionsSubmit
