American Diabetes Association: Survey - ADA Advocacy: Young Professionals Registration Page

Your Info

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Name:

First Required	Last Required

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E-mail: Required

Street 1:

Street 2:

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City/State/ZIP:

City	State Required	ZIP Required

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Country: Required

Yes, I would like to receive e-mail from American Diabetes Association

Yes, I would like to receive postal mail from American Diabetes Association

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Question - Required - Which of the following topics are you most interested in?

	Access to Adequate and Affordable Health Care
	Diabetes Research, Programs and Innovation
	Discrimination
	Health Equity
	Prevention

Question - Not Required - What is your profession/job?

Question - Not Required - What activities are you most interested in

	Recruiting new advocates
	Highlighting Advocacy at a local ADA or community event
	Writing to elected officials (using ADA's easy templates)
	Meeting with, establishing relationship with elected officials
	Social media Advocacy
	Traditional media letters to editor or op-ed writing (using ADA's tips and talking points)

Question - Not Required - Advocacy Main Interest Opt In

Advocacy Opt In