Diabetes Partners in Action Coalition  
Registration Form
DPAC Full Membership Meeting
October 8, 2010
9:30-4:00pm, Orientation begins at 9:00am
Kellogg Conference Center, East Lansing MI
Please submit your registration information by filling in the form below.
* Are required fields. Registration deadline is September 17, 2010.

* First Name:
* Last Name:
* Organization:
* Address:
Address 2:
* City:
* State:
* Zip:
* Phone:
Fax:
* Email:
Race/Ethnicity (optional):
* Organization Sector – Please choose at least one that best describes your affiliation or organization.









DPAC Workgroup and Committees – Please choose only one that you plan to participate in at this meeting.

Workgroup/Committee
Purpose
Increase public awareness and improve DPAC internal communication.
Advocate for people with diabetes; address health disparities and access to care issues.
Improve and promote culturally relevant and sensitive diabetes education services and care.
Expand diabetes primary prevention activities.
Identify and enhance available data systems; support other DPAC workgroups' data needs.
Recruit and retain broad-based DPAC membership.
Accommodations
If you have special needs that require an accommodation to fully participate, please let us know here:
Would you like to be contacted about your accommodation?
  
How would you like to be contacted?
  
Deadline to request accommodations: September 17, 2010. After this date, we will do our best to accommodate you but can make no guarantees.
Orientation Session
All DPAC members are welcome to join us for this session to learn more about DPAC's mission, structure, goals and objectives.
Contact Megan Goff with registration questions:
Phone: 517-335-8853
Email: goffm1@michigan.gov
Please register by September 17, 2010