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
-
Month
-
Day
Year
Date
Your Name
*
First Name
Last Name
Your Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Your Email
*
example@example.com
Applicant's Name
*
First Name
Last Name
Briefly state how long and in what capacity you have known this applicant.
*
I am confident this individual has experience treating eating disorders.
*
Yes
No
I work in the field of eating disorders.
*
Yes
No
I am currently a MEDA Professional Member.
*
Yes
No
Please select the appropriate option.
*
I recommend this individual for professional membership with MEDA.
I have reservations about recommending this person.
Please provide any further comments about this applicant.
*
E-Signature
*
Submit
Print Form
Should be Empty: