Back to 2002 Conference 2002 Conference Registration

Diabetes 123 Conference and Expo -- July 17-21, 2002
Registration Form


Street Address:


City, State, ZIP, Country:

Email Address:

Daytime Phone:


Registration Fee
Early Registration (before April 1, 2002): $250
Regular Registration (April 1-July 1, 2002): $275
Late registration (after July 1, 2002): $300

Family Registration includes 2 adults and their accompanying children under age 18. Additional adults are $25 per person.

Family and Event Information (Please include every person attending)
First Name Last Name If under
18, age
of child
Family and
Friends Banquet
Adults $30
Child (3-11) $15
(Thursday night)
Dining with
the Experts
Adult $30
Child $10
Teen Dance (12+) $10
(Friday night)
CWDF Benefit
Universal Studios
Adult $40
Child (3-11) $30
(Saturday all day)
Event Totals: $ $ $
Sum of Events: $
Registration Fee (see above): $
Extra t-shirts or tanks:
$10 each, mark sizes and quantity below
Additional Tax Deductible Donation to the CWD Foundation: $
Grand Total: $

T-Shirt or tank tops: Please enter quantity. Include one shirt for each person attending (ok to mix and match tanks and tees). Additional shirts may be purchased and are $10 each (see above). Shirts will not be available for sale at the conference. We highly recommend buying additional shirts, so you can wear a fresh shirt each day of the conference.

Adult  __Small  __Med  __Large  __X Large  __XX Large
Child  __Small  __Med  __Large 

Tank tops
Adult  __Small  __Med  __Large  __X Large  __XX Large
Child  __Small  __Med  __Large 

Registration for all participants includes:

Pump Sessions:
The pump sessions taught by John Walsh are by ticket only and are limited to 50 people per session. If you wish to attend a pump session, please indicate which session and the names of the people who will be attending.

Names of Attendees
Thursday Friday


Method of Payment:
__ VISA   __ Mastercard   __ Check made payable to "Diabetes 123"

Card Number:

Expiration Date:

Name as it appears on the card:

Billing address if different than above:

Signature (required):

Please mail your registration to:   Laura Billetdeaux
Events Coordinator
319 E. Duncan
Manchester, MI 48158

Or fax your registration form to Laura Billetdeaux at 734-428-0106.

2002 Conference and Expo
2002 Conference - Highlights - Faculty
Thursday - Friday - Social Events
Sponsors - Exhibitors - Registration
Map of Attendees
Report from 2001 - Report from 2000

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Last Updated: Monday December 16, 2002 10:25:10
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