Diabetes 123 - Diabetes Youth Ambassador Sign Up



		Diabetes Youth Ambassador Sign Up

Sign up to be an International Diabetes Youth Ambassador

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.

My name is:

My email address is:

My birthday is: Year: Month: Day:

Who has diabetes?

Type of diabetes?

I'm from:

What part of your country are you from?

Is information about diabetes easily obtained in your country? Yes No

Our medical care is:

Is your country involved in research for diabetes medical conditions? Yes No Don't Know

Is your country involved in research for a cure for diabetes? Yes No Don't Know

Are there diabetes support groups where you live? Yes No Don't Know

How much do people in your country know about diabetes?

Are you allowed to manage your diabetes at your desk at school? Yes No

If not, how do you manage your diabetes at school?

Are teens at your school accepting of your diabetes? Yes No

Because of my diabetes I have not been able to:

Because of my diabetes, I have been able to:

Have you ever attended a diabetes summer camp? Yes No Don't Know

When I grow up I want to be:

If I could help other people with diabetes I would:

I think diabetes advocacy is important because:

If you have advocated for diabetes before, what kind of work have you done?

I would like to become an International Diabetes Youth Ambassador because:

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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Sign up to be an International Diabetes Youth Ambassador

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.

My name is:

My email address is:

My birthday is:		Year: Month: Day:

Who has diabetes?

Type of diabetes?

I'm from:

What part of your country are you from?

Is information about diabetes easily obtained in your country?		Yes No

Our medical care is:

Is your country involved in research for diabetes medical conditions?		Yes No Don't Know

Is your country involved in research for a cure for diabetes?		Yes No Don't Know

Are there diabetes support groups where you live?		Yes No Don't Know

How much do people in your country know about diabetes?

Are you allowed to manage your diabetes at your desk at school?		Yes No If not, how do you manage your diabetes at school?

Are teens at your school accepting of your diabetes?		Yes No

Because of my diabetes I have not been able to:

Because of my diabetes, I have been able to:

Have you ever attended a diabetes summer camp?		Yes No Don't Know

When I grow up I want to be:

If I could help other people with diabetes I would:

I think diabetes advocacy is important because:

If you have advocated for diabetes before, what kind of work have you done?

I would like to become an International Diabetes Youth Ambassador because:

		We will contact you by e-mail after we receive and read your submission.