Survey form

Thank you for visiting DEAR Diabetes

Please let us know what brought you to our site.

We would like to get your feedback about the best ways to reach the diabetic community and what events you would like to see offered in the future.

	Check all that apply
Google Search
Friend
Gala
Luncheon
Radio
Postcard
Social Media
Other

If you selected other, please provide more information. If you answered Postcard, please tell us the location. This will help us determine the effectiveness of our advertising.

Educational Event

Please provide feedback regarding your interest in an educational event

Click here to see highlights from 2023

Please select your preferred month(s) in order of preference

Educational Event additional comments or suggestions

DEAR Diabetes Gala

Please provide feedback regarding your interest in our annual Gala

Please select your preferred month(s) in order of preference

Please select the evening day of week in order of preference

What ticket price would you feel comfortable paying for the Gala and to assist diabetics in our community?

Tell us about the experiences you like at Galas. Check all that apply

Gala additional comments or suggestions.

DEAR Diabetes Dynamite Diabetic Divas

We know first-hand how managing your diabetes day-to-day can seem overwhelming.

DEAR Diabetes wants to celebrate all of our Dynamite Diabetic Divas with a day just for you.

Let us know if you would be interested in attending a fun afternoon event featuring local women business vendors, fashion, chair massages, drawings, maybe some education, and so much more!!!

We would love to hear your feedback.

By the way, you don't have to be diabetic to attend. Your support is so important to all women in our community.

If you are interested in attending, please answer the next set of questions, otherwise, feel free to skip ahead.

Please indicate your interest in each of the events

Educational Event

Gala

Dynamite Diabetic Divas

Gala + Dynamite Divas same day

Additional Comments

Your Name

	9 - 11	11 - 1	1 - 3	3 - 5
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

	With Lunch	Without Lunch
$20 - $24
$25 - $34
$35 - $44
$45 - $54

	Panel Format	Individual Speakers
Nutrition
Diabetes Complications
Foot/Wound Care
Eye Care
Primary Care or Diabetic Doctor
Personal Success Story
Social Services
Emotional

	11 - 3	12 - 3	1 - 4	2 - 5
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

	With Lunch	Without Lunch
$20 - $24
$25 - $34
$35 - $44
$45 - $54