{"id":367,"date":"2021-10-29T14:00:18","date_gmt":"2021-10-29T18:00:18","guid":{"rendered":"https:\/\/site.extension.uga.edu\/gnc\/?page_id=367"},"modified":"2026-03-25T16:08:52","modified_gmt":"2026-03-25T20:08:52","slug":"2021-gnc-membership-form","status":"publish","type":"page","link":"https:\/\/site.extension.uga.edu\/gnc\/2021-gnc-membership-form\/","title":{"rendered":"2024 GNC Membership Form"},"content":{"rendered":"\n<p>Thank you for your interest in joining Georgia Nutrition Council! We are excited to have you a part of the family. GNC was created to bring together professionals who are interested in nutrition to broaden their perspectives, provide connection with like-minded individuals, and to unite our efforts. Thank you for adding to our efforts to address nutrition problems in the State. See you at the next event!<\/p>\n\n\n<script>(function() {\n\twindow.mc4wp = window.mc4wp || {\n\t\tlisteners: [],\n\t\tforms: {\n\t\t\ton: function(evt, cb) {\n\t\t\t\twindow.mc4wp.listeners.push(\n\t\t\t\t\t{\n\t\t\t\t\t\tevent   : evt,\n\t\t\t\t\t\tcallback: cb\n\t\t\t\t\t}\n\t\t\t\t);\n\t\t\t}\n\t\t}\n\t}\n})();\n<\/script><!-- Mailchimp for WordPress v4.12.5 - https:\/\/wordpress.org\/plugins\/mailchimp-for-wp\/ --><form id=\"mc4wp-form-1\" class=\"mc4wp-form mc4wp-form-364 mc4wp-form-theme mc4wp-form-theme-red\" method=\"post\" data-id=\"364\" data-name=\"Membership!\" ><div class=\"mc4wp-form-fields\"><style>\r\n  legend {\r\n \tfont-weight: 700; \r\n }\r\n  fieldset {\r\n    border: none;\r\n    padding: 0;\r\n    margin: 0;\r\n}\r\n\r\nfieldset div {\r\n    display: flex;\r\n    align-items: center;\r\n    gap: 0.5em;\r\n}\r\n<\/style>\r\n<p>\r\n    <label for=\"email\">Email address<\/label>\r\n    <input type=\"email\" name=\"EMAIL\" id=\"email\" required=\"\">\r\n<\/p>\r\n<p>\r\n    <label for=\"fname\">First Name<\/label>\r\n    <input type=\"text\" name=\"FNAME\" id=\"fname\" required=\"\">\r\n<\/p>\r\n<p>\r\n    <label for=\"lname\">Last Name<\/label>\r\n    <input type=\"text\" name=\"LNAME\" id=\"lname\" required=\"\">\r\n<\/p>\r\n<p>\r\n    <label for=\"mmerge7\">Home Address<\/label>\r\n    <input type=\"text\" name=\"MMERGE7\" id=\"mmerge7\">\r\n<\/p>\r\n<p>\r\n    <label for=\"mmerge8\">Home City<\/label>\r\n    <input type=\"text\" name=\"MMERGE8\" id=\"mmerge8\">\r\n<\/p>\r\n<p>\r\n    <label for=\"mmerge9\">Home Zip Code<\/label>\r\n    <input type=\"text\" name=\"MMERGE9\" id=\"mmerge9\">\r\n<\/p>\r\n<p>\r\n    <label for=\"mmerge6\">Employer<\/label>\r\n    <input type=\"text\" name=\"MMERGE6\" id=\"mmerge6\" required=\"\">\r\n<\/p>\r\n<p>\r\n    <label for=\"mmerge12\">Title<\/label>\r\n    <input type=\"text\" name=\"MMERGE12\" id=\"mmerge12\" required=\"\">\r\n<\/p>\r\n<p>\r\n    <label for=\"mmerge13\">Work Address<\/label>\r\n    <input type=\"text\" name=\"MMERGE13\" id=\"mmerge13\">\r\n<\/p>\r\n<p>\r\n    <label for=\"mmerge14\">Work City<\/label>\r\n    <input type=\"text\" name=\"MMERGE14\" id=\"mmerge14\">\r\n<\/p>\r\n<p>\r\n    <label for=\"mmerge15\">Work Zip<\/label>\r\n    <input type=\"text\" name=\"MMERGE15\" id=\"mmerge15\">\r\n<\/p>\r\n<p>\r\n    <label for=\"mmerge19\">Membership Type<\/label>\r\n    <select name=\"MMERGE19\" id=\"mmerge19\" required=\"\">\r\n        <option value=\"Professional Membership\" selected=\"true\">Professional Membership<\/option>\r\n        <option value=\"Retired Membership\">Retired Membership<\/option>\r\n        <option value=\"Student Membership\">Student Membership<\/option>\r\n    <\/select>\r\n<\/p>\r\n<p>\r\n<fieldset>\r\n    <legend>Donation<\/legend>\r\n    <div>\r\n        <input type=\"radio\" name=\"MMERGE20\" id=\"donation-alley\" value=\"Holly B. Alley Scholarship\">\r\n        <label for=\"donation-alley\">Holly B. Alley Scholarship<\/label>\r\n    <\/div>\r\n    <div>\r\n        <input type=\"radio\" name=\"MMERGE20\" id=\"donation-waters\" value=\"Rita Waters Scholarship\">\r\n        <label for=\"donation-waters\">Rita Waters Scholarship<\/label>\r\n    <\/div>\r\n    <div>\r\n        <input type=\"radio\" name=\"MMERGE20\" id=\"donation-general\" value=\"General Fund\">\r\n        <label for=\"donation-general\">General Fund<\/label>\r\n    <\/div>\r\n<\/fieldset>\r\n<\/p>\r\n<p>\r\n<fieldset>\r\n    <legend>Payment Type<\/legend>\r\n    <div>\r\n        <input type=\"radio\" name=\"MMERGE16\" id=\"payment-paypal\" value=\"Paypal\" required=\"\">\r\n        <label for=\"payment-paypal\">Paypal<\/label>\r\n    <\/div>\r\n    <div>\r\n        <input type=\"radio\" name=\"MMERGE16\" id=\"payment-check\" value=\"Money Order\/Check\" required=\"\">\r\n        <label for=\"payment-check\">Money Order\/Check<\/label>\r\n    <\/div>\r\n<\/fieldset>\r\n<\/p>\r\n<p>\r\n    <input type=\"submit\" value=\"Submit\">\r\n<\/p><\/div><label style=\"display: none !important;\">Leave this field empty if you&#8217;re human: <input type=\"text\" name=\"_mc4wp_honeypot\" value=\"\" tabindex=\"-1\" autocomplete=\"off\" \/><\/label><input type=\"hidden\" name=\"_mc4wp_timestamp\" value=\"1779030899\" \/><input type=\"hidden\" name=\"_mc4wp_form_id\" value=\"364\" \/><input type=\"hidden\" name=\"_mc4wp_form_element_id\" value=\"mc4wp-form-1\" \/><div class=\"mc4wp-response\"><\/div><\/form><!-- \/ Mailchimp for WordPress Plugin -->\n\n\n<hr class=\"wp-block-separator has-css-opacity is-style-wide\"\/>\n\n\n\n<div class=\"wp-block-buttons is-horizontal is-content-justification-center is-layout-flex wp-container-core-buttons-is-layout-03627597 wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button has-custom-width wp-block-button__width-50\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/www.paypal.com\/paypalme\/gagnc?mc_cid=ce1cf6f0ac&amp;mc_eid=e1d58bde2d\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>Paypal<\/strong><\/a><\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-buttons is-horizontal is-content-justification-center is-layout-flex wp-container-core-buttons-is-layout-03627597 wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link wp-element-button\"><strong>Mail to: Georgia Nutrition Council P.O. Box 345, Locust Grove, GA 30248<\/strong><\/a><\/div>\n<\/div>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Thank you for your interest in joining Georgia Nutrition Council! We are excited to have you a part of the family. GNC was created to bring together professionals who are interested in nutrition to broaden their perspectives, provide connection with like-minded individuals, and to unite our efforts. Thank you for adding to our efforts to [&hellip;]<\/p>\n","protected":false},"author":330,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-367","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/site.extension.uga.edu\/gnc\/wp-json\/wp\/v2\/pages\/367","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/site.extension.uga.edu\/gnc\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/site.extension.uga.edu\/gnc\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/site.extension.uga.edu\/gnc\/wp-json\/wp\/v2\/users\/330"}],"replies":[{"embeddable":true,"href":"https:\/\/site.extension.uga.edu\/gnc\/wp-json\/wp\/v2\/comments?post=367"}],"version-history":[{"count":9,"href":"https:\/\/site.extension.uga.edu\/gnc\/wp-json\/wp\/v2\/pages\/367\/revisions"}],"predecessor-version":[{"id":554,"href":"https:\/\/site.extension.uga.edu\/gnc\/wp-json\/wp\/v2\/pages\/367\/revisions\/554"}],"wp:attachment":[{"href":"https:\/\/site.extension.uga.edu\/gnc\/wp-json\/wp\/v2\/media?parent=367"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}