Registration Form

Registration Form

2014 Diabetes Patient Tele-Education Programs

When you hit the SUBMIT button, this form is automatically emailed to the program director.
(Required)
(Required)
(hospital, health department, community health center, etc.)
(Required)
(Required)
(Required)
It is helpful for us to know in advance about your interest in participating in the educational programs. If you are uncertain about your schedule for the entire year, you may sign up for educational programs on a per program basis.
Please check the tele-education program(s) your site would like to participate in for 2014. All classes are from 1:00 - 3:00 pm.
When you hit the SUBMIT button, this form is automatically emailed to the program director and registrars.