Honoree Questionnaire 2021

Thanks for submitting your information for the 2021 Myabetic Diabetes Awards!

1. Name: This field is required

2. Name to share publicly (If different from #1) This field is required

3. How do you pronounce your name? This field is required

4. Social Media @handle This field is required

5. Where are you from/living? (City, State/Providence, Country) This field is required

6. Diabetes Diagnosis Date (Year only) This field is required

7. Mailing Address This field is required

8. Select ONE of the following questions to answer in 60 words or less: Why do you choose to publicly share your thoughts about diabetes on social media? How do you feel about living with diabetes, and has this changed from the past? What or who inspires you most to care for your diabetes? What are you most proud of about your diabetes journey? A memorable diabetes story or incident you’d like to share? This field is required

9. Send audio or video file of you reading your award-winning caption to awards@myabetic.com. Refer to email for post specifics. This field is required