Northland Celiacs Support Group Membership Form

The Northland Celiac Support Group is a support and educational group for adults and children with celiac (sprue) disease and/or dermatitis herpetiformis. Our medical advisor is Dr. Roger Gebhard, M.D.

Annual membership dues for NCSG are $20.00.

Benefits of membership include receiving Northland Celiac News. The newsletter highlights current research and news regarding celiac disease, and includes gluten-free recipes, product and restaurant reviews, and upcoming events and meetings in the Twin Cities.

Membership Form

Name  

Address  

City     State    ZIP  

Home phone  

Cell phone  

Email address      Receive E-Alert

Please check:
Adult patient         Child         New member         Renewing

Willing to Help:
Program         Hospitality Transportation         Publicity         Newsletter
Research         Educational Outreach         Special Projects

Celiac Sprue Association (CSA) member:    yes    no

Please make your check payable to NCSG and mail to:
Judy Bruels
Membership Chair
7477 W. 142nd Street Ct.
Apple Valley, MN 55124
952-432-0266 judybmn1@yahoo.com