Healthy Living with Diabetes Registration
Workshop Timing:Mondays Starting Oct :29th-Dec 3rd 4:30pm-7:00pm
Workshop Located at UniteMKE campuses: 2474 N 37th St. Milwaukee, WI 53210
Contact Workshop Leader Lakeeta at: 414-435-0506 or lakeeta@unitemke.org
Email address *
First and Last Name *
Your answer
Phone Number *
Your answer
Do you have Diabetes? *
Do you know someone with Diabetes? *
Do you require any accommodations?
Your answer
Do you have any food allergies?
Your answer
Do you speak English?
Are you bringing anyone with you? *
If so, How many people?
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google.