Start a Chapter of the College Diabetes Network

About You!

Please provide an email that you will check often!

Your Health Info

Your Chapter/School Information

Please include a couple different dates and times that work best. Don't forget to include your timezone!

Name of individual who referred you to this form.

Mailing Address
When we receive your form, we'll mail you a copy of our Chapter Handbook! The Chapter Handbook is full of helpful tips and guidance in getting your Chapter started. 

Please give us the best mailing address for us to send you a copy of our Chapter Handbook: