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Event Registration


Seattle, WA - Diabetes EXPO
April 18, 2009
Qwest Field Event Center

10 a.m. – 5 p.m.
First Name*
Middle Initial 
Last Name*
Address1*
Address2
City*
State*
Zip*
Telephone*
E-mail*
   
   
Number of household members attending the EXPO, including yourself.
   
Which media source did you hear about us? (list these answer choices) -> Radio; TV; Print; Online; Other Media?
   
Which retail source did you hear about us? (answer choice list) -> Wal-Mart; Cub; Safeway; Other Retail/Pharmacy?
   
Which personal source did you hear about us? (answer choice list) -> Healthcare Provider; Family/Friend; Other Personal?
   

 

By submitting this registration, I hereby waive all claims against the American Diabetes Association, its sponsors, and any personnel for any injury I might suffer in this event. I grant full permission for the American Diabetes Association to use photographs of me in legitimate accounts and promotions of this event.
Yes, Please keep me informed with ADA email newsletters.

  *   required
  
Print coupon for VIP entrance!