A Whole Person Approach to Diabetes Management | Presentation & Discounted Blood Draws

REGISTRATION REQUIRED—

Your Name

First Name *

Last Name *

Phone Number

Email Address

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Names of Others Joining You & Note if getting optional blood draw

OPTIONAL $25 Per Blood Draw. Can be paid in cash at the event.

Total Number in Your Group

Payment Option

Cardholder Name

Credit Card #

Expiration Date

Security Code

Billing Zip Code

Your total payment will be .

Your credit balance will cover

Your credit card will be charged

Your bank account will be charged

Diabetes Education & Support Group