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Please fill in your contact information to enable us to provide you personalized details about events and resources specially designed for you.
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Name *
Name of Child (In case your child has diabetes)
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Phone # *
 WhatsApp # or Signal # (If available)
Email Address
City *
Do You have diabetes? *
Which Type? *
If No, Please specify your Relationship with Diabetes *
Required
Date/year of diagnosis *
Are you vaccinated for COVID-19? *
I hereby give my consent to Meethi Zindagi's to use my picture/video on social media taken during the event. *
Optional
Social Media (Enter your profile handle)
Facebook
Instagram
Twitter
*Disclaimer : Your personal data is protected as per our data privacy policy and will only be used by Meethi Zindagi for providing you personalized information about resources, services and event updates. The demographic data / statistics may be used for developing better programs, services and projects to suit the group needs, or for demographic research and may be shared with our partners and affiliates without revealing any personal information to any third party.
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