Atlanta Metro Celiacs
Membership Application

Members of the Atlanta Metro Celiacs receive:
- Membership Directory
- Meeting notices and communication via eemail
- Bi-monthly newsletter filled with inforrmation on gluten free reading, vendors, events, recipes, etc.
- Free admission to the 2008 Gluten Free Vendor Fair
- Gluten Free Restaurant list of more thaan 60 local restaurants with a gluten free menu

The membership year runs from January through December.

To join:

Print this page out from your computer, fill out the form (only one membership per household is necessary), enclose a $15 membership fee, and mail it to be received by December 31st to:


Atlanta Metro Celiacs
6482 Debbie Sue Lane
Morrow, GA 30260

Family Name _______________________________________________________

Please list the Celiacs in the family ______________________________________

___________________________________________________________________

Address ____________________________________________________________

City ____________________________State ______  Zip Code________________

Email address _______________________________________________________

Phone number _______________________________________________________


If your doctor is celiac knowledgeable please provide the following:
Type of Doctor:  	
0   Primary Care Physician/Internal Medicine          0  Dermatologist
0   Gastroenterologist                                              0  Pediatric Gastroenterologist 
0   Dietician                          	 
			
Physician's Name ___________________________________

Address ___________________________________________

City ____________________________State ______  Zip Code____________

Phone number ______________________________________


Please use the back of the sheet if you are listing more than one doctor.
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