Diabetes Awareness Order Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

The Wisconsin Lions Foundation, Inc. (WLF) is committed to fighting the diabetes epidemic by raising awareness and educating communities and individuals about their risk. WLF and our partners have created a comprehensive program centered around creating awareness about diabetes through prevention, risk reduction and other diabetes resources. Please fill out this form to order diabetes awareness materials.

Have you ordered diabetes awareness materials from WLF before? *

This is my first order.

I have ordered diabetes awareness materials before.

What Lions District are you in? *

Other:

Please list the name of your Lions Club. *

Please list the name of who these items will be shipped to. *

Please list the mailing address of where the items should be shipped. *

Please list the best phone number to call if we have questions about this order. *

Clear form

Never submit passwords through Google Forms.

Forms

This form was created inside of Wisconsin Lions Foundation.