PODS/Quarterly Meeting Form

First Name

Last Name

Street Address

City

Closest City/Metropolitan Area (especially important if you live in a rural area)

Distance (in miles)

State (if in US)

Zip Code

Email address

Confirm Email Address

Country

I am interested in:

Attending a PODS Meetup in my area Hosting a PODS Meetup at my home Attending a Quarterly Gathering in my area Organizing a Quarterly Gathering in my area

I consent for DiabetesSisters Staff to release my name and email address to (only) DiabetesSisters members who are also interested in attending or hosting a PODS Meetup and/or Quarterly Gathering in my local area.

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Phone Number (best to reach you)

I prefer to be contacted by

Phone Email Mail

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