¤ Partners ¤

 

    SUBSCRIPTION FORM

If you wish to become a PARTNERS of ADAQ, please fill in this form directly on the screen and print it. (if you wish, you can also print it first the fill it in by hand. When done, forward it to the following address with your payment of 100.00 $ made out to ADAQ.

Corporation:
Last Name:
First Name:
Title:
Address:
City:
Postal Code:
Administrative region:
Phone:
Extension:
Fax:
E-mail:

Sectors of practice:

Health
Private pratice, administration
Industry
Private  practice, communication
Private pratice, nutrition
Other:

Questions and suggestions :
 

Association des diététistes au Québec
11, rue Charlevoix, suite A-106,Montréal, Québec, H3J 2V9, Tél. :(514) 954-0047, Fax : (514) 932-8108