children with DIABETES - 2010 Friends for Life Retinal Screening Request

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		2010 Friends for Life Retinal Screening Request

Online Retinal Screening Signup is now closed. Please check at registration to sign up.

Once again, free retinal screening is offered at Friends for Life. Screening is only for people with type 1 diabetes. Please submit a separate Retinal Screening Request for each family member to be screened.

Name

Parent
(If under 18)

E-mail address (parent's email if person is under 18)

Cell Phone (In case we need to contact you at the conference; parent's if person is under 18)

Age group

Adults Teens Youth

Adult (18+) tubing pump
Adult (18+) patch pump
Adult (18+) MDI
Teen (13-18) tubing pump
Teen (13-18) patch pump
Teen (13-18) MDI
Youth (12 or under) tubing pump
Youth (12 or under) patch pump
Youth (12 or under) MDI

For each member of your family, please select three times for retinal screening, in order of preference. We will notify you of your time within three days.

Choice #1:

Choice #2:

Choice #3:

IMPORTANT: You must be registered for the conference before your retinal screening request will be considered. If you have not registered, use the registration link below to do so before you submit any focus group requests.

Friends for Life 2010 Conference and Expo

Introduction - Program Overview - Exhibitors - Sponsors

Faculty - Youth Faculty - Grandparents Faculty - CWD Staff

Schedule: Parents & Adults - Youth - Focus Groups - Focus Groups Signup

Registration - FAQs

FFL Reports from 2009 - 2008 - 2007 - 2006 - 2005 - 2004 - 2003 - 2002 - 2001

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Last Updated: Monday June 28, 2010 11:28:57
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