5K@EASD run/walk to change diabetes

5K@EASD run/walk online entry

Please fill in this form completely, as incomplete forms cannot be processed.

48th EASD Annual Meeting attendees will pick up their race packets at the Novo Nordisk booth in the Messe Berlin Exhibition Halls.

Citizens of Berlin and race participants not attending the 48th EASD Annual Meeting will pick up their race packets beginning at 16.30 on Thursday 4 October at the run/walk start area.

*First name:

*Last name:

Institution:

Street, No. / PO Box:

City

Postal code:

*Country:

*E-mail:

*Repeat E-mail:

*I plan to:

*Gender:

*Age group:

T-shirt size:

T-shirts are provided to the first 3,000 registrants, courtesy of Novo Nordisk.

*I am attending the 48th EASD Annual Meeting:

*I have read and accepted the Release of Liability.

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