Join us in our search for ways to prevent,
better treat, and ultimately cure type 1 diabetes.
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The JDRF Illinois Online Diabetes Support Team
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Your first name:
Your last name:
Your e-mail address:
What town or city do you live in?:
Who has diabetes?
Pick One
Myself
My Child
My Niece/Nephew
My Grandchild
My Mom/Dad
My Friend
My Uncle/Aunt
My Brother/Sister
My Spouse
My Cousin
Someone Else
If not you, what is the person's name?
How old is this person?
Pick one
Under 2
2-5
6-9
10-12
Teenage
College Age
Adult
Is this person male or female?
Male
Female
At what age was the person diagnosed?
In what month and year was the person diagnosed?
Please feel free to include any questions or comments:
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