MEMBERSHIP APPLICATION FORM FOR FULL / STUDENT /AFFILIATE MEMBERSHIP OF ANS

• Current Contact Information
• Payment
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Email

Title

Forename

Surname

Address 1

Address 2

Postcode

Country

Telephone (incl std code)

Fax (incl std code)

Email

Sex

- Select -MaleFemale

African Nutrition Society Membership Number

Which of the following best describes your place of work? (Please tick as applicable)

Food & Agriculture Sector

Government

Healthcare/Public Health

Higher Education/Research

Industry

Media/Communications

Non-governmental Organization

Non-profit/Charity/Pressure Group

Self-Employed

Student

Which of the following best describes your job? (Please tick as applicable)

Administrator/IT Specialist

Lecturer/Teacher/Professor

Marketing/Sales/Customer Care

Medical Doctor/Clinical Dietician/Nutritionist/Nurse etc

PR/Media/Communications Specialist

Product Development/Regulatory Affairs

Public Health/Health Promotions Specialist

Researcher/Research Co-ordinator

Statistician/Methodologist

Student

Do you have another area of interest/expertise? (If not listed above)

Would you like to join one or more of the African Nutrition Society Thematic Forums?

Cellular, Molecular Nutrition & Metabolism

Community Health & Nutrition Education

Emergency Nutrition

Food Science, Food Chain & Animal Nutrition

Food Security, Agriculture & Health Economics

International Nutrition & Global Health

Maternal and Child Health & Nutrition

Medical, Clinical & Applied Nutrition

Micronutrient Nutrition

Nutrition, Media & Public Engagement

Nutritional Epidemiology and Public Health

School Health & Nutrition

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