Registration

The registration for the Diabetes Virtual Winter Camp is now CLOSED, and we hope you will join us for the Diabetes Virtual Spring Camp, coming in April 2021.

All registered students are expected to attend the full program. You will receive a confirmation of registration upon approval from the American Diabetes Association.

Registration is free with suggested donation. Your generous contributions will be donated to the American Diabetes Association to support diabetes research, education, and care.

NOTE: We have had an overwhelming response to our program, and the registration process is taking longer than expected. Please be patient, and you will receive a registration confirmation email once approved.

Student's First Name

Student's Last Name

Gender

Age (must be 14 or over)

Email Address

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number

Country

(###)

###

####

Parent or Guardian Information **Only for students under 18 years old.**

Parent/Guardian Name

First Name

Last Name

Parent/Guardian Email Address

Additional Information

Current School Attending

What is your career interest?

What do you hope to gain from this virtual program?

How did you hear about our program?

Have you previously attended a Diabetes Virtual Camp program?

2020 Summer Camp

2020 Fall Camp

N/A

Do you consider yourself as an underrepresented minority in the field of Science and Medicine?

I consent the Diabetes Virtual Camp to use photos taken during the Zoom sessions on the website and social media platforms.

Registration is free with suggested donation. Would you be willing to donate?

**Your generous contributions will be donated to the American Diabetes Association.**