Maine-based organizations, whether they are large or small, for-profit or non-profit, community or worksites, can create and edit their own profile pages that promote NDPP classes and programs. Organization profiles are available to the public.

If you would like to create a profile for your organization, please complete the form below to request a username and password. The form will be submitted to DPH and you will be contacted within 7 days. If you have any questions, please email info at rethinkdiabetes org com.

Please note: The information that you input on this form will be used to generate your organizations profile and will be available to the public.

Organization Name *

Organization

Organization Description

Organization Type *

• Community Organization
• Health System
• Worksite

Organization Address *

City *

State *

Zip *

Organization Phone *

Organization Email *

Preferred Way to Contact

• Email
• Phone

Organization Admin *

Patricia WatsonAshley LauzeAlicia RiceDebbie PottleElizabeth LylesLouise IngrahamThomas PsyataLisa Van DykAmy HendersonMichelle AllenDragos STANCUStephanie GagneTest Test

Organization Logo

• Remove
• Edit

No image selected

Approved

Admin First Name *

Admin Last Name *

Admin User Name *

Admin Password *

Confirm Password *

Please confirm password

I completely agree with the terms and conditions of this website.

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