MeADE Maine Association of Diabetes Educators Application for Membership     Name: _________________________________________________________       Credentials: ______________ DUES REMINDERS WILL BE SENT VIA EMAIL. PLEASE INDICATE YOUR PREFERRED EMAIL AND PHONE CONTACT INFORMATION.    Work Info:    Business:__ ____________________________________________________   Address:________________________________________________________ Town/Zip: ______________________________________________________ County:________________________________________________________ Telephone number:__________________Email:_______________________ Home Info: Address:________________________________________________________ Town/Zip:________________________________________________________ County:_________________________________________________________ Telephone number:________________Email:___________________________ ------------------------------------------------------------------------------------- Joining through National AADE ______I am a member of National AADE.  My member # is_________________ ______I will join MeADE through National AADE & pay dues through them (www.aadenet.org). ------------------------------------------------------------------------------------- If not joining through NationalAADE, local chapter dues are $20.00. Please mail this application, and your check for $20.00 made out to "MeADE" to:                          Kathy Jacques                          MEADE                          P.O. Box 1258                          Damariscotta, Me 04543   Send Kathy updates on your contact information.                Remember to check our website to keep up to date on all of our activities www.mainediabeteseducators.org