Supporting Families
Living with Diabetes
through the use of Community Advocacy, Social Media, & BLUE Flamingos!

Your Subtitle text

Ambassador Application

Do YOU want to share your diabetes story with the world? I'm looking for some Type 1 friends who would like to help spread diabetes awareness across the globe, while living their life in a POSITIVE way with diabetes!

If you are interested, please ask your parent to fill out the application below!

Ambassador Applicant's Name:
Ambassador Applicant's Date of Birth:
Parent's Name:
Email Address:
Telephone Number:
Street Address:
City, State, Zip Code:
If you live outside of the U.S., please list mailing address here:
In applicant's own words, why to YOU want to become an ambassador for The Diabetes Dude?: