Diabetes Registration | CovidKY

Class will meet every Thursday May 5^th-26^th5:30-7:30 pm at the Montgomery County Civic Center. Participants will receive a Diabetes Class Kit and those who attend 4 classes will be entered to win a $100 gift card. Class size is limited. To join the class please complete the following information.

Confirmation Number

Name(Required)

First Last

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Birth Date(Required)

MM slash DD slash YYYY

Telephone #(Required)

Email

How long have you lived with diabetes?(Required)

Recently diagnosed

Less than 1 year

Less than 5 years

More than 5 years

I do not have diabetes but want to learn more

What are you interested in learning about diabetes?(Required)

How would you like to receive class reminders or updates?(Required)

(Check all that apply)

Text

Email

Phone

None

Can we leave a message?(Required)

Yes

No

Schedule Date(Required)

COVID Restrictions: Class size is limited to offer adequate spacing. We will follow CDC and local recommendations for indoor masking. If you are sick or feeling unwell, please stay home.

To cancel registration or for other questions or concerns, please call 859-497-2448 or email AnnieM.Hill@ky.gov.

© Copyright 2022 Covid KY - All rights reserved. Powered By: AD-IOS