Dining With Diabetes- Registration Form
Registration form
Registration Form
Name:______________________________________
Mailing Address: _____________________________
City: _______________ Zip Code:_______________
*Phone Number: ______________________________
*Cell Phone Number:___________________________
Payment: _____$25.00 for primary attendee
_____$10.00 second attendee
_____Total Paid
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For office use only
_____cash _____check – check number____
*will only be used if class is cancelled due to weather
