Registration

Our Diabetes Virtual Summer Camp 2021 is scheduled for August, and the new registration page will open in July. Please wait for the Summer Camp registration site to open in July 2021. Thank you.

Student's Name

First Name

Last Name

Age

Email Address

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number

(###)

###

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

Parent/Guardian Name

First Name

Last Name

Parent/Guardian Email Address

Additional Information

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

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?

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

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

Registration

Diabetes Virtual Camp