The Power of the Pen, by Duke AL – 13-16 year olds - Diabetes Ireland : Diabetes Ireland

Registration Details for The Power of the Pen Workshop, by Duke AL - 13-16 year olds

"*" 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 13 - 16 years old *

Yes

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

Yes