Diabetes Ireland > Registration Details – The Power of the Pen, by Duke AL – 10-13 year olds

Registration Details – The Power of the Pen, by Duke AL – 10-13 year olds

Registration Details for The Power of the Pen Workshop, by Duke AL - 10-13 year olds (1)

"*" indicates required fields

Child Name

First Last

Parent/Guardian Name

First Last

DOB

Address*

Street Address Address Line 2 City Eircode Country

Phone Number*

Email*

Please confirm that your child has been diagnosed with Type 1 Diabetes and is within the age group 10-13 years old *

Yes

Please confirm that you are happy to be contacted by phone and/or email by Diabetes Ireland. *

Yes