Recommendation for MEDA's Professional Membership Network
Thank you for filling out this brief form to inform us of your recommendation of this applicant as a professional member with the Multi-Service Eating Disorders Association (MEDA). MEDA is a nonprofit organization dedicated to treatment of eating disorders and disordered eating. Please indicate if you would recommend this applicant as a professional with experience in the field of eating disorders.
Today's Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Your Name
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First Name
Last Name
Your Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Your Email
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example@example.com
Applicant's Name
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First Name
Last Name
Briefly state how long and in what capacity you have known this applicant.
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I am confident this individual has experience treating eating disorders.
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Yes
No
I work in the field of eating disorders.
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Yes
No
I am currently a MEDA Professional Member.
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Yes
No
Please select the appropriate option.
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I recommend this individual for professional membership with MEDA.
I have reservations about recommending this person.
Please provide any further comments about this applicant.
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E-Signature
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