Registration Form
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Email *
Name *
Salutation (Prof, Dr, MD, Mr, Mrs, Ms) *
Country of Origin *
State or Province *
Current Institution/school *
Role in the Institution/school *
Area of Expertise in Diabetes (Ex: DM type 1, diabetic feet ulcer, diabetic feet ulcer, diabetes technology) *
e-mail address *
Phone number
A copy of your responses will be emailed to the address you provided.
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