School Walk for Diabetes: Sign Up for School Walk for Diabetes

Interested in School Walk for Diabetes?
Not ready to register and need more info? Complete our short "I'm Interested" online form and we'll be in touch soon.

Register your school for School Walk for Diabetes!
Simply complete the following registration form and we'll take care of the rest! Once we've received your school's registration form your local School Walk coordinator will be in touch with you soon.

Contact Information

Name:

Title	First Required	Middle Required	Last Required	Suffix

E-mail: Required

*2.

Question - Required - School Name

*3.

Question - Required - School's Street Address

Question - Not Required - Address 2

*5.

Question - Required - City

*6.

Question - Required - State

*7.

Question - Required - ZIP Code

*8.

Question - Required - School Phone Number

*9.

Question - Required - School Fax Number

10.

Question - Not Required - Alternate Contact Number

*11.

Question - Required - Your role at school

12.

Question - Not Required - School Principal's Name (if not you)

*13.

Question - Required - School District

*14.

Question - Required - My school primarily represents the following grade level range: Elementary school (K-6)
Middle School (7-8)
High School (9-12)
Elementary-Middle (K-8)
Elementary-High (K-12)

*15.

Question - Required - When would you like to have your School Walk for Diabetes? The exact day you select is flexible.

Month

Day

Year

*16.

Question - Required - What is the maximum number of students that might participate in your School Walk for Diabetes?

*17.

Question - Required - What is the fund-raising goal for your school?

*18.

Question - Required - What is the best time to contact you?

*19.

Question - Required - What is the best way to contact you about School Walk for Diabetes? Phone (School Number)
Phone (Alternate Number)
E-mail
U.S. Mail

20.

Question - Not Required - How did you hear about School Walk for Diabetes?


Thanks to Our National Promotional Sponsor:	Home \| Printer Friendly \| Privacy Statement & COPPA Information \| Contact Us American Diabetes Association © 2009. All rights reserved.