Membership Application Membership Application First Name * Last Name * Degree Affiliation E-mail * IGDS is building a website to facilitate connecting those with similar interests. Would you like to be listed on this website? * Yes No Your interests (check all that apply): Clinical Care Clinical care Technology use Long-term care Home setting Clinical guidelines End of life Comorbidities Acute hospitalizations Other Please specify Education Education PCPs Students Long-term care staff Other Please specify Research Research Technology use Frailty Epidemiology Cognition Screening & Prevention of Diabete Health services Comorbidities & Complications Glycemic control Clinical trials Registries Nutrition Laboratory (bench) Other Please specify Personal Information (check all that apply): Main work place Comprehensive care clinic Primary Care Hospital University hospital Industry Laboratory Private practice Research Institute Long term facility Other Please specify Professional Role Researcher Clinical practitioner Clinical researcher Industry/Corporate professional Nurse/other health care professional Resident/fellow Student Other Please specify Specialty Endocrinology, Diabetes & metabolism Cardiology & vascular medicine Geriatrics Family medicine Internal medicine Other Please specify Are you interested in serving as a Mentor? * Yes No Are you interested in obtaining a Mentor? * Yes No Are you interested in joining the American Diabetes Association Interest Group on Improving the Care of Older Adults with Diabetes? * Yes No Submit If you are human, leave this field blank.
