HOW DO I PARTICIPATE?

*If you think you may be eligible and have a sibling that may also be eligible and willing to participate, please complete the form. We are requesting that you enter in your email address and your sibling’s email address. Once you submit the form, the information will be sent to PBRC and an email will be sent to your sibling on your behalf directing him/her back to this page. Once we have received your sibling’s information, our staff will contact you.

*If you are a mother who has adult children that may be interested in participating, please fill out the form and select “mother.” Please give us your name, phone number and email address along with the contact information for your children. Once you submit the form, the information will be sent to PBRC and an email will be sent to your children on your behalf directing them back to this page. Once we have received everyone’s information, our staff will be in contact.

If you and/or your sibling do not have an email address, or if you would like further information before completing the form, please give us a call at 225.763.3000.

ENTER YOUR INFORMATION
Are you a mother with diabetes, or a child who was exposed to diabetes?
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Child 1