Diabetes Education Network. Registration Form. The Diabetes Education Network (DEN) Diabetes & Chronic Diseases Unit - Public Health Branch. Manitoba Health …
Diabetes Education Network
Registration Form
The Diabetes Education Network DEN is a network of over 500 diabetes
educators ranging from community diabetes workers to certified diabetes
educators Membership is voluntary and open to health professionals and
providers who plan, develop and/or deliver education to people with or at
risk for diabetes in Manitoba and NW Ontario
If you would like to receive DEN mailings and information about the annual
DEN Workshop, please complete this Registration Form
Name: _______________________________________________________________
Position Title: _________________________________________________________
Professional Designation: _______________________________________________
Business Address: _____________________________________________________
Street
Box Number
_____________________________________________________________________
Town/City Province
Postal Code
Business Telephone : ___________________Business FAX
: ________________
E-mail Address: _______________________________________________________
First Nations Affiliation if applicable:
_______________________________________
Community Name/Address
Signature: _________________________ Date: _____________________________
I would like to receive information regarding future meetings/inservices
I give permission to release my name to pharmaceutical companies for
purposes of receiving information on current products/events
Please return this information and provide any future changes to:
Lynn Craig
Diabetes Chronic Diseases Unit - Public Health Branch
Manitoba Health
300 Carlton Street Winnipeg MB R3B 3M9
Telephone: 204 788-6732
FAX: 204 948-3430
Source:uta.edu
