Registration Form

It is important for the DRN to have the views of people affected by diabetes - and only with your help will we be able to improve the methods of care, treatment, prevention and diagnosis of diabetes across the UK.

Name
Email
Telephone
Where do you live?
County

I am interested in answering questionnaires or surveys

I am interested in participating in a clinical trial or research study

I am interested in becoming a Patient Advocate

I wish to be kept informed of the Network's activities

What best describes you? (Please tick all that apply)

I am a person with Type 1

I am a friend, relative, or carer of a person with Type 1

I am a parent of a person with Type 1

I am a person with Type 2

I am a friend, relative, or carer of a person with Type 2

I am a parent of a person with Type 2

Other Type (please state in message box below)

I do not have diabetes

Where did you hear about the DRN?

Message

We will only use the information you provide to contact you about the Diabetes Research Network. We will never wilfully disclose personal information about you to any third party without first receiving your permission to do so, or unless we are under legal obligation to do so. We may include literature from other organisations that we consider may be of interest to you within our own distributed materials.