Language
  • English (US)
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  • Please select a registration option:*
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  • Is this your first time attending a Touched by Type 1 Conference?*
  • Birthdate*
     - -
  • Format: +1 (000) 000-0000.
  • Languages Spoken*
  • Ethnicity*
  • What is your relationship to Type 1 Diabetes? Check all that apply.*
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  • Diagnosis Date*
     - -
  • Management (check all that apply)*
  • Glucose Monitoring*
  • Mild Hypoglycemia Rescue*
  • Severe Hypoglycemia Rescue*
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  • Which adult session(s) will you be attending?*
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  • Dietary restrictions- please check all that apply*
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  • Would you like to add an emergency contact for yourself?*
  • Format: (000) 000-0000.
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  • Would you like to register another registrant?*
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  • ▪ Birthdate*
     - -
  • ▪ Languages Spoken*
  • ▪ Is this their first time attending a Touched by Type 1 Conference?*
  • ▪ Ethnicity*
  • ▪ What is the registrant's relationship to Type 1 Diabetes? Please select all that apply.*
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  • ▪ Diagnosis Date*
     - -
  • ▪ Management (check all that apply)*
  • ▪ Glucose Monitoring*
  • ▪ Mild Hypoglycemia Rescue*
  • ▪ Severe Hypoglycemia Rescue*
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  • ▪ Childcare*
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  • ▪ Which youth session(s) will this registrant be attending?*
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  • ▪ Which teen session(s) will this registrant be attending?*
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  • ▪ Which adult session(s) will this registrant be attending?*
  • Session Populate
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  • ▪ Dietary Restrictions- please check all that apply*
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  • ▪ Would you like to add an emergency contact for this registrant?*
  • ▪ Are you the primary emergency contact for this registrant?*
  • Format: +1 (000) 000-0000.
  • ▪ Would you like to add an additional emergency contact for this registrant?*
  • Format: +1 (000) 000-0000.
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  • ▪ Would you like to add another registrant?*
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  • ◦ Birthdate*
     - -
  • ◦ Languages Spoken*
  • ◦ Is this their first time attending a Touched by Type 1 Conference?*
  • ◦ Ethnicity*
  • ◦ What is the registrant's relationship to Type 1 Diabetes? Please select all that apply.*
  • Image field 694
  • ◦ Diagnosis Date*
     - -
  • ◦ Management (check all that apply)*
  • ◦ Glucose Monitoring*
  • ◦ Mild Hypoglycemia Rescue*
  • ◦ Severe Hypoglycemia Rescue*
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  • ◦ Childcare*
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  • ◦ Which youth session(s) will this registrant be attending?*
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  • ◦ Which teen session(s) will this registrant be attending?*
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  • ◦ Which adult session(s) will this registrant be attending?*
  • ◦ Session Populate
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  • ◦ Dietary Restrictions- please check all that apply*
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  • ◦ Would you like to add an emergency contact for this registrant?*
  • ◦ Are you the primary emergency contact for this registrant?*
  • Format: +1 (000) 000-0000.
  • ◦ Would you like to add an additional emergency contact for this registrant?*
  • Format: +1 (000) 000-0000.
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  • ◦ Would you like to add another registrant?*
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  • ◊ Birthdate*
     - -
  • ◊ Languages Spoken*
  • ◊ Is this their first time attending a Touched by Type 1 Conference?*
  • ◊ Ethnicity*
  • ◊ What is the registrant's relationship to Type 1 Diabetes? Please select all that apply.*
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  • ◊ Diagnosis Date*
     - -
  • ◊ Management (check all that apply)*
  • ◊ Glucose Monitoring*
  • ◊ Mild Hypoglycemia Rescue*
  • ◊ Severe Hypoglycemia Rescue*
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  • ◊ Childcare*
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  • ◊ Which youth session(s) will this registrant be attending?*
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  • ◊ Which teen session(s) will this registrant be attending?*
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  • ◊ Which adult session(s) will this registrant be attending?*
  • ◊ Session Populate
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  • ◊ Dietary Restrictions- please check all that apply*
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  • ◊ Would you like to add an emergency contact for this registrant?*
  • ◊ Are you the primary emergency contact for this registrant?*
  • Format: +1 (000) 000-0000.
  • ◊ Would you like to add an additional emergency contact for this registrant?*
  • Format: +1 (000) 000-0000.
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  • ◊ Would you like to add another registrant?*
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  • ♦ Birthdate*
     - -
  • ♦ Languages Spoken*
  • ♦ Is this their first time attending a Touched by Type 1 Conference?*
  • ♦ Ethnicity*
  • ♦ What is the registrant's relationship to Type 1 Diabetes? Please select all that apply.*
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  • ♦ Diagnosis Date*
     - -
  • ♦ Management (check all that apply)*
  • ♦ Glucose Monitoring*
  • ♦ Mild Hypoglycemia Rescue*
  • ♦ Severe Hypoglycemia Rescue*
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  • ♦ Childcare*
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  • ♦ Which youth session(s) will this registrant be attending?*
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  • ♦ Which teen session(s) will this registrant be attending?*
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  • ♦ Which adult session(s) will this registrant be attending?*
  • ♦ Session Populate
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  • ♦ Dietary Restrictions- please check all that apply*
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  • ♦ Would you like to add an emergency contact for this registrant?*
  • ♦ Are you the primary emergency contact for this registrant?*
  • Format: +1 (000) 000-0000.
  • ♦ Would you like to add an additional emergency contact for this registrant?*
  • Format: +1 (000) 000-0000.
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  • ♦ Would you like to add another registrant?*
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  • ☼ Birthdate*
     - -
  • ☼ Languages Spoken*
  • ☼ Is this their first time attending a Touched by Type 1 Conference?*
  • ☼ Ethnicity*
  • ☼ What is the registrant's relationship to Type 1 Diabetes? Please select all that apply.*
  • Image field 818
  • ☼ Diagnosis Date*
     - -
  • ☼ Management (check all that apply)*
  • ☼ Glucose Monitoring*
  • ☼ Mild Hypoglycemia Rescue*
  • ☼ Severe Hypoglycemia Rescue*
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  • ☼ Childcare*
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  • ☼ Which youth session(s) will this registrant be attending?*
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  • ☼ Which teen session(s) will this registrant be attending?*
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  • ☼ Which adult session(s) will this registrant be attending?*
  • ☼ Session Populate
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  • ☼ Dietary Restrictions- please check all that apply*
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  • ☼ Would you like to add an emergency contact for this registrant?*
  • ☼ Are you the primary emergency contact for this registrant?*
  • Format: +1 (000) 000-0000.
  • ☼ Would you like to add an additional emergency contact for this registrant?*
  • Format: +1 (000) 000-0000.
  • Image field 1031
  • ☼ Would you like to add another registrant?*
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  • ► Birthdate*
     - -
  • ► Languages Spoken*
  • ► Is this their first time attending a Touched by Type 1 Conference?*
  • ► Ethnicity*
  • ► What is the registrant's relationship to Type 1 Diabetes? Please select all that apply.*
  • Image field 858
  • ► Diagnosis Date*
     - -
  • ► Management (check all that apply)*
  • ► Glucose Monitoring*
  • ► Mild Hypoglycemia Rescue*
  • ► Severe Hypoglycemia Rescue*
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  • ► Childcare*
  • Image field 871
  • ► Which youth session(s) will this registrant be attending?*
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  • ► Which teen session(s) will this registrant be attending?*
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  • ► Which adult session(s) will this registrant be attending?*
  • ► Session Populate
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  • ► Dietary Restrictions- please check all that apply*
  • Image field 881
  • ► Would you like to add an emergency contact for this registrant?*
  • ► Are you the primary emergency contact for this registrant?*
  • Format: +1 (000) 000-0000.
  • ► Would you like to add an additional emergency contact for this registrant?*
  • Format: +1 (000) 000-0000.
  • Image field 1032
  • ► Would you like to add another registrant?*
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  • ∆ Birthdate*
     - -
  • ∆ Languages Spoken*
  • ∆ Is this their first time attending a Touched by Type 1 Conference?*
  • ∆ Ethnicity*
  • ∆ What is the registrant's relationship to Type 1 Diabetes? Please select all that apply.*
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  • ∆ Diagnosis Date*
     - -
  • ∆ Management (check all that apply)*
  • ∆ Glucose Monitoring*
  • ∆ Mild Hypoglycemia Rescue*
  • ∆ Severe Hypoglycemia Rescue*
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  • ∆ Childcare*
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  • ∆ Which youth session(s) will this registrant be attending?*
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  • ∆ Which teen session(s) will this registrant be attending?*
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  • ∆ Which adult session(s) will this registrant be attending?*
  • ∆ Session Populate
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  • ∆ Dietary Restrictions- please check all that apply*
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  • ∆ Would you like to add an emergency contact for this registrant?*
  • ∆ Are you the primary emergency contact for this registrant?*
  • Format: +1 (000) 000-0000.
  • ∆ Would you like to add an additional emergency contact for this registrant?*
  • Format: +1 (000) 000-0000.
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  • ∆ Would you like to add another registrant?*
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  • □ Birthdate*
     - -
  • □ Languages Spoken*
  • □ Is this their first time attending a Touched by Type 1 Conference?*
  • □ Ethnicity*
  • □ What is the registrant's relationship to Type 1 Diabetes? Please select all that apply.*
  • Image field 938
  • □ Diagnosis Date*
     - -
  • □ Management (check all that apply)*
  • □ Glucose Monitoring*
  • □ Mild Hypoglycemia Rescue*
  • □ Severe Hypoglycemia Rescue*
  • Image field 946
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  • □ Childcare*
  • Image field 951
  • □ Which youth session(s) will this registrant be attending?*
  • Image field 953
  • □ Which teen session(s) will this registrant be attending?*
  • Image field 955
  • □ Which adult session(s) will this registrant be attending?*
  • □ Session Populate
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  • □ Dietary Restrictions- please check all that apply*
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  • □ Would you like to add an emergency contact for this registrant?*
  • □ Are you the primary emergency contact for this registrant?*
  • Format: +1 (000) 000-0000.
  • □ Would you like to add an additional emergency contact for this registrant?*
  • Format: +1 (000) 000-0000.
  • Image field 1034
  • □ Would you like to add another registrant?*
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  • ◘ Birthdate*
     - -
  • ◘ Languages Spoken*
  • ◘ Is this their first time attending a Touched by Type 1 Conference?*
  • ◘ Ethnicity*
  • ◘ What is the registrant's relationship to Type 1 Diabetes? Please select all that apply.*
  • Image field 978
  • ◘ Diagnosis Date*
     - -
  • ◘ Management (check all that apply)*
  • ◘ Glucose Monitoring*
  • ◘ Mild Hypoglycemia Rescue*
  • ◘ Severe Hypoglycemia Rescue*
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  • ◘ Childcare*
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  • ◘ Which youth session(s) will this registrant be attending?*
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  • ◘ Which teen session(s) will this registrant be attending?*
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  • ◘ Which adult session(s) will this registrant be attending?*
  • ◘ Session Populate
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  • ◘ Dietary Restrictions- please check all that apply*
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  • ◘ Would you like to add an emergency contact for this registrant?*
  • ◘ Are you the primary emergency contact for this registrant?*
  • Format: +1 (000) 000-0000.
  • ◘ Would you like to add an additional emergency contact for this registrant?*
  • Format: +1 (000) 000-0000.
  • Image field 631

  • The following questions help us keep our programs and events free for participants and better understand, reach, and serve the Type 1 diabetes community.

  • How did you first hear about this event?*
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  • Is your healthcare provider affiliated with a hospital or clinic?*
  • Which hospital or clinic?*
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  • Which platform?*
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    • Read - Assumption of Risk and Release of Liability 

    • Participation in this event is voluntary. I understand that there may be inherent risks associated with participation in community events and activities. I voluntarily assume all risks associated with my participation and the participation of any minor for whom I am registering.

      In consideration of being permitted to participate in this event, I hereby release, waive, and hold harmless Touched by Type 1, including its officers, directors, employees, volunteers, committee members, partners, sponsors, donors, and the venues hosting the program, from and against any and all claims, liabilities, damages, losses, costs, or expenses, including reasonable attorney’s fees, arising out of or related to my participation in this event or the participation of any minor for whom I am responsible.

      I understand that Touched by Type 1 provides educational and community support programming and does not provide medical advice or medical services during this event.

    • Read - Photo and Video Release 

    • I grant permission to Touched by Type 1, its partners, and event sponsors to photograph, record, and/or film me and any minor for whom I am registering during the event. I understand that these images or recordings may be used by Touched by Type 1 for educational, promotional, marketing, or fundraising purposes, including use on websites, social media, printed materials, and other media platforms, without compensation.

    • Read - Emergency Medical Authorization for Minors 

    • If I am registering a minor participant, I confirm that I am the parent or legal guardian of the minor and authorize the minor’s participation in the event.

      In the event of a medical emergency involving the minor during the event, I authorize Touched by Type 1 representatives, volunteers, or event staff to seek appropriate medical treatment for the minor, including contacting emergency medical services if necessary. I understand that I am responsible for any costs associated with such medical care.

    •  
    • By checking this box, I agree to receive occasional automated event related marketing text messages from Touched by Type 1 at the phone number provided. Consent is not a condition to register. Msg & data rates may apply.*

    • Acknowledgment

      By completing registration and signing below, I acknowledge that I have read, understand, and agree to this Participant Waiver and Release of Liability.

      By submitting this form I agree to receive email communications from Touched by Type 1. I understand I can unsubscribe at any time using the link in any email.

    • Form Language*
    • Mailchimp AC Group*
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