Juvenile Diabetes Research Foundation. Kids for a Cure Lobby Day Juvenile Diabetes Research Foundation. 7100 Woodbine Avenue, Suite 311. Markham, Ontario L3R 5J2 …
Juvenile Diabetes Research Foundation
Kids for a Cure Lobby Day
October 28, 2008 -Ottawa, Ontario
Application Form please print all information in ink
| | |
| |Parent/Guardian |
|Name of Child | |
| |All applications, including the |
|Age Date of |biography must be received at the |
|Birth |address below by May 16, 2008 |
| | |
|Name of Parent/Guardian |By signing below I, as a parent or |
| |guardian, agree: |
|Address | |
| |To abide by the rules,
conventions, and|
|City |terms of the JDRF Kids for a Cure Lobby|
|Province |Day |
| |That my childs name and story become |
|Postal Code |the property of the Juvenile Diabetes |
| |Research Foundation and may be used in |
|Home Phone Work Phone |print, radio, television, internet |
| |with appropriate safeguards, and in |
|Childs e-mail |any other appropriate media to promote |
| |JDRFs mission and goals |
|Parents e-mail |That due to limitations of space and |
| |budget, only one parent or guardian |
|Local JDRF Chapter |will attend JDRFs Kids for a Cure |
| |Lobby Day |
|Your MP |Applicants must be committed to further|
| |developing relationship with MP
after|
|Please indicated which languages you |lobby day is over |
|are fluent in: | |
| |By signing below, I also indicate my |
|[ ] English [ ] French |understanding that: |
|[ ] Other -specify: | |
|_______________________ |There may be discussion of the |
| |complications of diabetes during the |
| |JDRF Kids for a Cure Lobby Day |
| |If there is discussion of such |
| |controversial topics as embryonic stem |
| |cell research, I will either embrace |
| |the JDRF legislative position on such |
| |topics or will not work against the |
| |JDRF position |
| |
|
| | |
| |Parent/Guardians signature |
| |Date |
|CHILD APPLICANT | |
| |Send this application form and your |
|Tell us about yourself |biography to: |
| | |
|On a separate sheet of paper, write a|Kids for a Cure Lobby Day |
|one-page biography of yourself We |Juvenile Diabetes Research Foundation |
|want to hear your personal story |7100 Woodbine Avenue, Suite 311 |
|about living with juvenile type 1 |Markham, Ontario L3R 5J2 |
|diabetes, why a cure for juvenile |Fax: 905 944-0800 |
|diabetes is important to you, and |E-mail: advocacy@jdrfca |
|your involvement with JDRF Tell us | |
|why you feel your presence in Ottawa |-by May 16, 2008-
|
|will make the difference and why the | |
|government should support diabetes | |
|research | |
| | |
|Make sure you put your name and | |
|address at the top of the sheet and | |
|attach your biography with your | |
|application form | |
Source:annarborfoot.com
