JDRF Speakers Bureau Form
If you are interested in becoming a member of the JDRF Southwest Ohio chapter's volunteer Speakers Bureau, please complete this form.
Your E-mail Address
What is the approximate distance (one way) you are willing to travel from your home address to present at an event?
Please provide a brief description of your experience with type 1 diabetes (T1D) and/or JDRF.
Please check (all that apply) the classifications that apply to you.
I am an adult with T1D
I have a child with T1D
I am the parent of a T1D
I am a medical professional
Chapter Research Information Volunteer (RIV)
Please check (all that apply) the groups you feel comfortable presenting to:
T1D Support Groups
Groups larger than 20 individuals
Please describe your approximate availability to speak at events (ex: I am not typically available during the day; I am available weekends only, etc.)
Do Not Fill This Out