CLT Course Order Form (For Registered Dietitians Only) Name* First Last Credentials*Phone*Email* Registration Number*Do You Have a Private Practice?*YesNoName of PracticeWebsite Who Referred You to LEAP?*Who is Your Preferred LEAP Mentor? (Choose One)*Jan Patenaude, RD, CLTSusan Linke, MBA, MS, RD, LD, CLTMichal Hogan, RD, CLTJulianne Koritz, MS, RD, CLT, LD/NLinda J. Bethel, MS, RDN, LDN, CLTDonna Wolf, RDN, CLTDiana C. Bright, MS, RD, CCN, CLT, CGP, NDNot sure which mentor to choose? Visit our Mentor Bios page.PhoneThis field is for validation purposes and should be left unchanged.