Diabetic Strong Enrollment Form

If you are human, leave this field blank.

First Name *

Last Name *

Address *

Address

Address 1 (Street)

Address 2 (Optional)

City

State/Province

Zip/Postal

Email *

Phone Number *

Workshop (Location/Date) *

No. of Participants *

Tell us about your diabetic journey and current A1c if known:

* You will receive a call and additional information regarding the upcoming workshop and details regarding hotel options.

Disclaimer: Information provided through this site and links to other sites is not designed to and does not provide medical advice, professional diagnosis or treatment to you or any other individual. Diabetic Strong provides general information for educational purposes only. The information provided here is not a substitute for medical care and should not be used in place of a visit, consultation or advice of your physician or other medical provider. Diabetic Strong is not liable or responsible for any advice, course of treatment, diagnosis or any other information, services, or product you obtain through this site. Any results demonstrated on this website or other links related to diabetes and/or weight loss is not a guarantee of similar outcomes. Every individual does and will respond differently to the information provided. Do not change any course of treatment without consulting your physician.