The Bahamas Diabetes Association
WORLD DIABETES DAY SYMPOSIUM FRIDAY, NOV 14, 2025 9am to 2:30pm St. Gregory’s Anglican Church Hall, Carmichael Road
Theme: Diabetes and Wellbeing Campaign Focus: Diabetes and the workplace
REGISTRATION FORM
Name
*
First & Last Name
Gender
Please Select
Male
Female
Date of birth
*
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Month
/
Day
Year
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Telephone
*
Primary Contact
(Home)
(000) 000-0000
(Cell)
(000) 000-0000
Email
example@example.com
Please select the option applicable to you:
Please Select
I have diabetes
I care for a family member with diabetes
I want to learn about diabetes
Would you like to be apart of the BDA Diabetes Support Group?
Please Select
Yes
No
Support Group
Date
-
Day
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Month
Year
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Signature of Applicant:
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