Diabetic Discount Club

First Name: Last Name:

Address:

Apt: City:

State: Zip:

Email:

Day Phone:

Your phone # will be part of your Unique Discount ID so be sure to enter it correctly.

Date of Birth:

Why do i need to provide this?
I would like to receive FREE membership to DiabeticDiscountClub and giving consent to its representatives and/or its affiliates to contact me about my medical supply needs and related products.

Get Great deals on...

By becoming a member of the Diabetic' Discount Club I will be eligible to receive discounts on products and services that I select interest in. Some of the services such as the discounted or no cost prescriptions and medical supplies may require verification of qualification and I understand that I may receive a call from such providers, even if I'm on a do-not-call list of any local, state or federal agency.

"CONSUMER ADVISORY: It has come to our attention that the Diabetic Discount Club brand may have been used by unathorized entities. If you have not registered to the club through an ad, a contest or any of our advertisements and have been contacted please report it by notifying the fraud department : 206-339-5669"

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