Membership Application

To become a member of the Gluten Management Association, please complete the form below. Membership fee in 2016 is complementary (free).

Your Name (required)

Your Address (required)

Your City (required)

Your Zip/Postcode (required)

Your Email (required)

Your Phone (required)

Your Mobile Phone

Your Skype (optional)

Are you joining as:

If you are joining as a company, what is your Company Name?(optional)

Does your company manufacture or produce food for consumers?(optional)

Are you:
Gluten intolerantCeliacChoose not to eat glutenInterested

Do you provide food for someone who is:
Gluten intolerantCeliacChoose not to eat glutenNone of those options apply to me

Do you prepare gluten free food in the home?
YesNo

Does anyone in your immediate family need to avoid gluten?
YesNo

Would you like to be nominated for the Gluten Management Association executive?
YesNo

Would you like to submit news updates and blogs for the GMA?
YesNo

Would you like to be part of the advocacy group on behalf of the GMA?
YesNo

Do you have any other comments or questions?

We look forward to receiving your application.