Membership

To learn more about our activities, to receive our invitations and to stay up to date with the latest news, become a member of the Foundation. This is free and without obligation. Let’s keep in touch by filling in the online form below.

If you prefer to send your form by regular mail, please use this Membership Form (FR-ENG)

Candidate information

First name

Last name

Mr. or Ms.

Address

City

Province

Postal code

Email address

Phone principal

Phone other

Profession

Company

I am

If you are the parent or legal tutor of children with diabetes, fill the following sections:

Partner information

First name

Last name

Mr. or Ms.

Address, if different than above

City

Province

Postal code

Email address

Phone principal

Phone other

Profession

Company

Child information

First name

Last name

Sex

Hospital

Doctor’s name

Date of birth (AAAA-MM-JJ)

Date of diagnose (AAAA-MM-JJ)

Spoken language(s)

Home

This information will remain confidential.

I support the cause of diabetic children and I want to make a donation

I would like to be contacted to volunteer.

I declare that the information provided above is accurate.