NMDAC June 2 Hybrid Training Registration Form

Full Name*

First NameLast Name

E-mail*

example@example.com

Phone Number*

I am a*

Individual NMDAC memberPart of a NMDAC organizational membershipNon-member - You will be invoiced for the $20 registration fee by email.

If you are part of an organizational membership, please indicate your organization:

I will attend the June 2 Training*

In person - Please specify any dietary needs belowVirtually - A zoom registration link will be sent to your email to complete. You will then receive your link to join the hybrid training.

I am attending in person and have a dietary need. My dietary request for lunch is:

Please indicate your dietary need. We will let you know if the caterer cannot supply food for your needs.

Please indicate what type of CEUs you will request:

New Mexico Diabetes Advisory Council June 2 Training Registration