Annual Commitment Form 2025

Member Benefits:

·Partnerships and networking
·Valuable diabetes resources available free of charge
·Advocate for state and local policy development
·Enhance job performance through professional and personal growth
·Expand diabetes knowledge, skills and leadership
·Influence and celebrate statewide progress in reducing the impact of diabetes and its complications

Member Responsibilities:

· Attend two of the four meetings/year.
· Actively participate and contribute in Action Team groups and committees. Click each title for a description.
Diabetes Prevention Program,
Diabetes Self-Management Education Support,
Partnerships & Networking,
Community Education & Advocacy
·Completion of assigned tasks during and between meetings.
·Annual membership renewal.
·Promote KDN and diabetes resources to colleagues, clients and community.
1.Name- First, Last
2.Credentials/Certification
3.Preferred Mailing Address, including County
4.Phone Number
5.Email Address
6.Employer/Organization
7.Position or Title
8.What Action Team are you willing to contribute to? (See links above for descriptions)
9.What will you do to be actively involved in KDN in 2024?
10.How can we serve you as a member?
11.Are you interested in being a part of our leadership team?  If so, please select one or more positions.
12.As an active member of the Kentucky Diabetes Network, Inc, I grant Kentucky Diabetes Network, Inc., its representatives and employees the right to take photographs of me and my property in connection with the above-identified subject.  I authorize Kentucky Diabetes Network, Inc. its assignees and transferees to copyright, use and publish the same in print and/or electronically. I agree that Kentucky Diabetes Network, Inc. may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.