Please complete the following form to pledge your support and join our mission in helping us reach 1 million people annually.

1. Organization Information:

Type of Organization (Please select):

—Please choose an option—CompanyChurchNGOGymClinicDepartment of HealthUniversityCollegeOther

2. Pledge to Collaborate and Support:

We pledge to support ShrinkBelly’s Diabetes Awareness Program in the following ways (check all that apply):

Host Educational Workshops: Offer venues and/or organize workshops on diabetes awareness, nutrition, and weight control for our employees/members/community.Provide Free Health Screenings: Assist in organizing free diabetes screenings and risk assessments for individuals in the community.Promote the Campaign: Use our platforms (social media, newsletters, etc.) to promote diabetes awareness and ShrinkBelly’s initiatives.Collaborate on Health Events: Participate in joint health fairs or community wellness events, providing outreach and education.Offer In-kind Resources: Provide in-kind resources such as venues, volunteers, or marketing support to help spread awareness.Fund or Sponsor Specific Initiatives: Contribute financially or sponsor specific activities such as glucometer donations, workshops, or fitness challenges.Encourage Employee/Member Participation: Promote participation in ShrinkBelly's diabetes education workshops, fitness programs, and health screenings.Collaborate on Research: Partner with ShrinkBelly on research efforts, data collection, and analysis to evaluate the impact of diabetes awareness initiatives.Other Ways to Collaborate (Please specify)

3. Expected Outcomes and Benefits for Your Organization

What does your organization hope to achieve from this collaboration?

4. Preferred Start Date for Collaboration

We would like to begin our collaboration on:

—Please choose an option—ImmediatelyWithin the next monthWithin the next 3 monthsOther (Please specify):

5. Additional Comments or Special Requests

How did you hear about us?*

ReferralAdFriendGoogleTikTokFacebookInstagramTwitterEmail

6. Agreement to Collaborate

We, commit to collaborating with ShrinkBelly in its mission to raise awareness, prevent diabetes, and promote weight control. We look forward to supporting this initiative and making a lasting impact in our community.

I accept all Terms and Conditions

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