Language
  • English (US)
  • Español
  • Image field 663
  • Is this your first time attending a Touched by Type 1 Community Connections event?
  • Image field 685
  • Languages Spoken
  • Format: (000) 000-0000.
  • Birthdate
     - -

  • Address

  • Which of the following describe you? Check all that apply.
  • Image field 599
  • Diagnosis Date
     - -
  • Current glucose monitoring
  • Current insulin management
  • Current mild hypoglycemia treatment
  • Current hypoglycemia prescriptions
  • Image field 677
  • Dietary restrictions (check all that apply)
  • 0/100
  • Ethnicity (check all that apply)
  • Would you like to add another person?
  • Image field 407
  • ▪ Is this their first time attending a Touched by Type 1 Community Connections event?
  • ▪ Birthdate
     - -
  • ▪ Languages Spoken
  • ▪ Which of the following describe this attendee? (Check all that apply)
  • ▪ Ethnicity (check all that apply)
  • Image field 593
  • ▪ Diagnosis Date
     - -
  • ▪ Current glucose monitoring
  • ▪ Current insulin management
  • ▪ Current mild hypoglycemia treatment
  • ▪ Current hypoglycemia prescriptions
  • Image field 678
  • ▪ Dietary Restrictions- please check all that apply
  • Image field 684

  • 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?
  • Image field 681
  • Image field 668
  • Is your healthcare provider affiliated with a hospital network?
  • Image field 670
  • Image field 669
  • Image field 673
  • Image field 674
  • Image field 635
    • Photo and Video Release 

    • 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.

    • Release of Liability 

    • 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.

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

    •  
    • I consent to sharing my registration information (specifically, my name and email address) with Touched By Type 1’s trusted partners and sponsors, like Tandem Diabetes Care, Inc. so that I can receive product-related follow-up and informational emails.
    • 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.
    • Form Language
  • Should be Empty: