CSA4th Annual CSA Dietitian Day
                    October 29, 2009




  Registration Form


Print Name:_____________________________________________________________ Date: ___________________________


City:______________________________________________________ State: _________ Zip: ___________________________

Telephone (required):________-________-__________ E-mail: _____________________________________________________


This program is reserved for dietitians and other medical professionals.

Dietitian Day Objectives:
At the conclusion of the program participants will be able to:

  1. Describe the pathophysiology of celiac disease
  2. Define medical nutrition therapy for celiac disease
  3. Identify at least two management strategies for celiac disease
  4. Describe the relationship between type 1 diabetes mellitus and celiac disease

Program & Speakers:

7:30 am – 7:55 am Registration & Information Desk
7:55 am – 8:00 am Welcome
8:00 am – 9:15 am Jean Guest, PhD, RD, LMNT
9:15 am – 10:30 am Dee Sandquist, MS, RD, CDE
10:30 am – 11:00 am Morning Break
11:00 am – 12:00 pm Veronica Alicea, RD, MBA
12:00 pm – 1:30 pm Gluten-Free Lunch
1:30 pm – 2:45 pm Mark Dinga, MEd, RD, LDN
2:45 pm – 3:15 pm Afternoon Break
3:15 pm – 4:30 pm Diana Stuber, MA, RD, CDE
4:30 pm – 5:30 pm Evaluation/Exhibit Hall


Early Registration Fee $165 Until 10/12/09
Late Registration Fee $215 After 10/12/09

Registration includes lunch, Dietitian Day Handbook,
speaker presentation recordings set, a compact disk
version of The CSA Gluten-Free Product Listing and
admission to the Conference Exhibit Hall.
Register by phone 1-877-CSA-4-CSA.

Seminar Location
Bayfront Convention Center - Erie, Pennsylvania

Accommodations Reservations
Sheraton Erie Bayfront Hotel - Erie, Pennsylvania
Identify yourself as part of the Celiac Support Association
September 29, 2009 will be the last day for CSA Conference
discounted room rates. Phone: 814-454-2005

Continuing Education
CPEU’s are being applied for through the American Dietetic
Association’s Commission on Dietetic Registration.

I have specific dietary needs
(gluten-free lunch and breaks)
Lactose-free Vegetarian

“Oktoberfest” Buffet
Continue the experience by enjoying delicious gluten-free selections. $40.00

Conference Exhibit Hall
Conference Exhibit Hall will feature a variety of gluten-free items from food manufacturers, suppliers and health food stores many offering products for sampling or purchase.

Photo/Video Statement
By attending this event it is agreed that photos/videos may be taken and used by CSA for promotional and educational purposes.

Special Assistance
CSA adheres to the articles of Title III of the 1990 Americans with Disabilities Act. If special assistance is required, notify CSA by 9/1/09.

Early Registration - Until 10/12/09 $165.00 x___
Late Registration - After 10/12/09 $215.00 x___
“Oktoberfest” Buffet $40.00 x___

First and Last Names of Participant(s) Amount
__________________________________________ $______
__________________________________________ $______
__________________________________________ $______
Total $______

Payment method: □ Check: Amount (Payable to the Celiac Support Association) ________________

Credit card:

Provide Visa Discover MasterCard American Express
Security Code: _________ _________ _________ _________


Credit card number:_____________________________________________________________Exp. Date: ___________________

Full name of cardholder (Please Print):_________________________________(Signature):_________________________________


No refunds will be issued once payment has been received. Forfeited fees will be retained as a donation to CSA.

Mail to CSA, PO Box 31700, Omaha, NE 68131