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  Diabetes Youth Ambassador Sign Up

Sign up to be an International Diabetes Youth Ambassador
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Become an International Diabetes Youth Ambassador and share your story! When you fill out our questionnaire, we will post your story on the Meet Us section of this website.
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My name is:  
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My email address is:  
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My birthday is:   Year: Month: Day:
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Who has diabetes?  
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Type of diabetes?  
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I'm from:  
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What part of your country are you from?  
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Is information about diabetes easily obtained in your country?   Yes No
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Our medical care is:  
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Is your country involved in research for diabetes medical conditions?   Yes No Don't Know
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Is your country involved in research for a cure for diabetes?   Yes No Don't Know
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Are there diabetes support groups where you live?   Yes No Don't Know
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How much do people in your country know about diabetes?  
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Are you allowed to manage your diabetes at your desk at school?   Yes No

If not, how do you manage your diabetes at school?
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Are teens at your school accepting of your diabetes?   Yes No
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Because of my diabetes I have not been able to:  
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Because of my diabetes, I have been able to:  
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Have you ever attended a diabetes summer camp?   Yes No Don't Know
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When I grow up I want to be:  
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If I could help other people with diabetes I would:  
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I think diabetes advocacy is important because:  
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If you have advocated for diabetes before, what kind of work have you done?  
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I would like to become an International Diabetes Youth Ambassador because:  
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We will contact you by e-mail after we receive and read your submission.

Ambassador Links
Ambassador Home - FAQs - Meet us! - Join us! - Take Action! - Diabetes Around the World - Trips - International Links


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URL: http://www.diabetes123.com/ambassador/signup.htm
Last Updated: Sat Dec 28 21:10:36 2002
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