2017 Diabetes Cook-Off Submission Form
Please read through the official contest rules, eligibility requirements, and other information before submitting a recipe here: https://goo.gl/WXkJkW
Email address *
Name *
Your answer
Year of Birth *
mm/dd/yyyy
MM
/
DD
/
YYYY
Primary Phone Number *
(xxx)xxx-xxxx
Your answer
Secondary Phone Number
(xxx)xxx-xxxx
Your answer
Email Address *
Your answer
(Optional) Has a doctor ever told you that you have Diabetes?
(Optional) If you were a participant in the South Side Diabetes Education class co-taught by Dr. Monica Peek, at what clinic did you have your class?
Recipe Categories (select one): *
Recipe Name *
Be original and creative!
Your answer
List the recipe ingredients – Remember to include measurements (Example: ½ cup of 1% milk or 2 carrots) *
Please list no more than 8 ingredients: (Do not include spices, oils, and garnish in this section)
Your answer
Please list spices, oils, and items for garnish and the amounts or measurements you need (these will not be counted with your 8 ingredients): *
Please Note: garnishes can be used for plate presentation only and cannot be used to enhance the flavor of your dish.
Your answer
List the step-by-step recipe directions. *
Your answer
What inspired you to cook healthy? *
Your answer
Send us a photo! (Optional)
We welcome all submissions to share a photo of the dish. This is not required.To submit a photo, please attach it in an email with your full name and the name of your recipe to: SouthSideDiabetes@gmail.com
A copy of your responses will be emailed to the address you provided.
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