We welcome your interest in becoming a member of the JDA.
Being a member will enable us to better understand the individual needs of those facing the challenges for the prevention and control of diabetes and diabetes health related issues and to continue serving the community and will give you the opportunity to be an actual part of these services….

. PRESENTLY THERE IS NO MEMBERSHIP FEE BUT YOUR DONATION WILL GO A LONG WAY IN HELPING US CONTINUE THE VITAL WORK THAT IS BEING DONE! In addition to your membership, become part of the mitzvah! “…From Every Person Whose Heart Inspires Him To Generosity, You Shall Take My Offering” (Exodus, chap. 25)

Friend $54
Sponsor $72
Supporter $118
Dedication $180
Patron $360 (option for side bar space on our website for 1 month)
Dedicate a page on our website with a banner $500 (for 1 month)
Other      


PAYMENT OPTIONS BELOW
Your donation is tax deductible

Name:

Address:

Street
City
State
Country
Zip

Phone:		Fax:
Email:

Date of Birth:

We would greatly appreciate additional information that will help us serve you better.
All information is strictly confidential and our lists are never shared. Thank you.

Marital status
Married
Single
Divorced/Widowed

Religion:

Who has diabetes
Self
Child
Spouse
Relative

Name of parents (If member under 18)
Name of spouse
Date of diagnosis

Name and address of Physician and/or Diabetes Center


Doctor’s address and telephone number:

Type of diabetes
Type 1
Type 2
Gestational
Pre-Diabetes
Prevention


Treatment
Medication
Insulin
Combination
Pump Type
CGM (Constant glucose monitor)
Diet & Exercise


Please tell us how you heard about us:

Do you wish to receive updates and information via e-mail?
Yes
No

PAYMENT OPTIONS:

Please make checks or money orders payable to Jewish Diabetes Association. Your donation can be mailed to our Brooklyn office

USA office: 1122 East 14th Street
Brooklyn NY, 11230



To dedicate any portion of this website and/or advertise kindly contact our office.