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About +
About DiD
Our Team
Partner With DiD
Contact
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Type 1 Navigator
Education +
Educational Initiatives
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Resources
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First name/ Nombre
Last name/ Apellido
Email/ Correo electrónico
Ethnicity
Hispanic or Latino / Hispano o Latino
Not Hispanic or Latino / No Hispano o Latino
Race
American Indian or Alaska Native / Indio americano o nativo de Alaska
Asian / Asiático
Black or African American / Negro o afroamericano
Native Hawaiian or Other Pacific Islander / Nativo de Hawái u otra isla del Pacífico
White / Blanco
Two or more races / Dos o más razas
Prefer not to answer / Prefiere no responder
Relation to Diabetes
Person living with Diabetes/ Persona que vive con diabetes
Family Member or Friend of Someone with Diabetes/ Familiar o amigo(a) de alguien con diabetes
Healthcare Professional / Educator/ Profesional de la salud / Educador(a)
Advocate / Community Leader/ Defensor(a) / Líder comunitario(a)
Researcher or Student/ Investigador(a) o estudiante
What do you hope to get from the summit. (Community, education, resources...) / ¿Qué espera obtener del evento? (Comunidad, educación, recursos...)
How did you hear about this event? / ¿Cómo se enteró de este evento?
Social media / Redes sociales
Email / Correo electrónico
Friend or family / Amigo o familiar
Healthcare provider / Profesional de salud
Flyer or poster / Volante o cartel
Other / Otro
Do you have any accessibility needs or accommodations?/ ¿Tiene alguna necesidad de accesibilidad o adaptación?
Do you want to get connected more with Diversity in Diabetes / ¿Quiere involucrarse más con Diversity in Diabetes?
Do you consent to Diversity in Diabetes to taking your photo and using your photo during promotional materials for the organization / ¿Da su consentimiento a Diversity in Diabetes para tomarle fotografías y usar su imagen en materiales promocionales de la
Would you like to make a donation? / ¿Le gustaría hacer una donación?
$5
$10
$25
Signature / Firma
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