HPCD: MN Diabetes Prevention System Survey (Renee Kidney)

Thank you for your interest in Building Minnesota’s Diabetes Prevention System by working with statewide partners who make up the Minnesota Diabetes Prevention Network.

We would like to include you in the Minnesota Diabetes Prevention Network. By completing this form, you will be on our email list and receive updates about diabetes prevention work across the state. Also, we will make you aware of opportunities to become more involved with collaborative diabetes prevention activities. You can determine your level of involvement, but with this information we are better able to bring opportunities to you.

Please fill out the following information using your business (and not personal) contact information

Your First Name

Your Last Name

Credentials

Job Title

Organization

Email Address

Work Phone

Work Address

Suite or Apartment (if applicable)

City

State

Zip

Please select the categories that describe your organization's work. (Check all that apply.)