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Please make checks payable to the Greater New Haven Celiac Group and send to: Betsey Powers, Treasurer, 7 Justine Drive, North Haven, CT 06473. 

____I would like to join the NH Celiac Group and am enclosing dues from September, 2003 to September, 2004. 

___$25.00 – new member ____ $20.00 for renewing member  

____I would like to order the New Patient Packet for Children or Adults @$15.00 each 

Name:      

Address:    

Phone: 

 
e-mail address: ________________ 

____I have CD ____I have DH ____ I have Celiac/Diabetes ____I am the parent of a celiac child  

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