CDSMP Registration Form
The Diabetes and Hypertension Association of Barbados in collaboration with the Pan American Health Organization and the Ministry of Health and Wellness is pleased to accept registration for the Chronic Disease Self-Management Programme Community Workshops.
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Email *
Surname *
First Name(s) *
Title *
Address *
Gender *
Date of Birth *
Contact Details (mobile) *
Contact Details (home) *
Contact Details (work)
Are you living with a chronic disease? *
Are you caring for someone who is living with a chronic disease? *
If yes, please tick as appropriate: *
Required
Name of Emergency Contact *
Relationship *
Contact Number(s) *
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