FREE EDUCATIONAL / COUNSELING SEMINAR
REGISTRATION FORM.
1-Please Select Date & Event Location:

2-Your Full Name:3-Your Status:

4-Membership # if applicable:5- Number of attendees per family:

6-Your age group: 7-Do you or any family members has Diabetes:

8-If yes please select one:     9- Have condition since:

10-Your current address:   Street Number & Name:
 
                                       City Name:Postal Code:Prov:
 
                                       Country:Tel:
 
                                       Email address:

11-Have you attended any previous course or seminar before at TBK:

12- If Yes Please specify date and location:

13- Disclaimer:
JDCCI is a Canadian registered charity founded privately by the parents and family members of children with various chronically illnesses specially kids with diabetes. JDCCI is offering these training sessions/seminars at no cost to those families and individuals involve in similar situation to create awareness,understanding for better control and care for cure. These training sessions and seminars are without any obligation and liability at JDCCI or its management/volunteers/professionals and board members. JDCCI seek/hires services from various health professionals for its members from time to time during training sessions and other programs. JDCCI id not responsible for any action or services offered or provided by any health professional privately and out side JDCCI's programs. JDCCi has not authorized any individual to collect any charity or donation without written authority from management which is posted in this website (donation programs link).
JDCCI reserve the right to accept or reject any application for this event registration with written or verbal explanation to the applicant. JDCCI will not share / keep record of any personal information without consent of the applicant /member.JDCCI will not disclose any personal information to any private or governmental agency without written consent of the applicant or member.

14-I the applicant whose name appears in box 2 of this form have read and understood above disclosure:

Signatures:(Please type your name as appears in box 2 again).

Please select and click on Submit to sen your registration form: