2016 Diabetes Cook-Off Submission Form
Please read through the official contest rules, eligibility requirements, and other information before submitting a recipe here: http://goo.gl/lhtpRH
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):
List the recipe ingredients.
(Please list no more than 8)
Your answer
Recipe Name
Be original and creative!
Your answer
List the step-by-step recipe directions.
Your answer
What inspired you to cook healthy?
Your answer
If your recipe is not original, please type the source below.
For example: ADA Cookbook 2011, Volume 3
Your answer
Send us a photo! (Optional)
We welcome all submissions to share a photo of the recipe. 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.
Please complete the captcha before submitting the form.
Submit
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