Final Call To Congress | 2020 Infographic Form

This form will be used to create your personal infographic for Call to Congress. Please enter your responses carefully. Double-check spelling, grammar and punctuation, because this will be given your senators and representatives!

As a 501(c)(3) nonprofit, the ADA and all Advocate Volunteers are prohibited from engaging in partisan political activity. For this reason, do not include partisan language in your responses as this language is not legally permissible for Call to Congress or other ADA advocacy functions.

For additional information about Call to Congress, click here.

Name

First NameLast Name

Email Address

CALL TO CONGRESS: INSTRUCTIONS TO SHARE YOUR STORY:

Please answer at least one of the three questions below, to share your own personal/professional story.

Speak from the heart, share your passion and emotions! We want the message to reflect your unique experience.
ADA staff will review all responses and may make slight edits to your text. One of the three answers will be selected to create your personalized infographic, for sharing with your lawmakers at Call to Congress.
You must limit your statement to no more than 375 characters. That’s about 60 words or 3 sentences.

Please note: You must answer at least one question in order to submit the form

What is the most important thing for members of Congress to understand about diabetes?

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What drives you to be a diabetes advocate? And what action do you want Congress to take to address your HOPES and/or FEARS?

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How does diabetes affect your everyday life? How have high insulin costs and/or the cost of other medications/diabetes devices affected you, your family, or your patients (if you’re a HCP)? How would your life be different if you did not have access to, or could not afford your diabetes medications and technology? If you have lived with diabetes for a long time, how has your life/diabetes management improved, thanks to research and improvements in treatment?

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Upload Photo

Browse Files

Please upload a photo for your personal infographic (square image is best, crop prior to upload, if possible.) Choose an image that captures your story. Show an accomplishment or a challenge, or include you and your pump, glucose meter or CGM.

Yes! Please share my story

I give the American Diabetes Association (Association), and any other persons the Association may designate, the absolute right and permission to use and publish without right of review any written version of my story and the photograph(s)/video(s) that I have provided, in any medium or form of distribution. I grant this permission without restriction and I understand I will receive no compensation for my images or story.

For more information please refer to American Diabetes Association’s privacy policy on how my data will be used

Call to Congress 2020