First Page
Welcome to the sign up form for the One Stop Shop hosted by the Belfast Trust, South Eastern Trust and Diabetes UK Northern Ireland - Together Type 1. This is an informal event for young people, aged 16-25 who are living with Diabetes in Northern Ireland. The event will be hosted at Parliament Buildings, Stormont on Tuesday 10th November, 14:00-17:00.
1.
Name of person completing form:
*
2.
I am a
*
Parent or Guardian
Young person aged over 18
3.
Email address:
*
4.
Phone number:
*
5.
Name of young person:
*
6.
Age of young person:
*
7.
Which health trust are you part of?
*
Belfast Trust
South Eastern Trust
Northern Trust
Southern Trust
Western Trust
8.
Are you already a member of Together Type 1?
*
Yes
No
Not sure
9.
Is your child already a member of Together Type 1?
*
Yes
No
Not sure
10.
Would you like to sign up to be part of Together Type 1? This means you'll be the first to hear about any events coming up in your area.
*
Yes please
No thank you
11.
So that we can put you in contact with the right Youth Team please could you confirm your post code?
*
12.
Please insert any questions you would like answered by our expert panel (these questions will be put to the panel anonymously). These can be anything related to
diabetes
, particularly
diabetes
in young adults.
