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Preferred Method of Contact
Your Email Address
Confirm Email Address
Cell Phone Number
State / Province / Region
ZIP / Postal Code
Do you have a child (18 or younger) with diabetes?
In order to best serve your child with diabetes and family, please share your child's name and date of birth. This information helps us to provide you with the best information and programs that would be appropriate for your child.
Name of Child with Diabetes
Birthdate of Child with Diabetes
MM slash DD slash YYYY
What is your interest in Camp Seale Harris (check all that apply)?
I would like to get Camp Seale Harris's e-news delivered to me.
I want information about Camp Seale Harris programs for my child/family member (camps, support, activities).
I want to donate to Camp Seale Harris.
I used to attend Camp Seale Harris.
By submitting this form, you are consenting to receive marketing emails from: Southeastern Diabetes Education Services, 500 Chase Park South, Suite 104, Birmingham, AL 35244.
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