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* 1. First Name:

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* 2. Last Name:

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* 3. Phone Number:

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* 4. Email Address:

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* 5. If you would like to register other individuals for this event, please enter their information in the boxes below:

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* 6. If you would like to register other individuals for this event, please enter their information in the boxes below:

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* 7. If you would like to register other individuals for this event, please enter their information in the boxes below:

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* 8. If you would like to register other individuals for this event, please enter their information in the boxes below:

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* 9. What is the most difficult part of living with diabetes (choose all that apply):

Thank you for your registration. If you have any questions, please contact Lisa Knoll at 715-387-9357 or via email at knoll.lisa@marshfieldclinic.org.

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