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