Advocacy Network Form

YES! Please sign me up to become part of the National Kidney Foundation of Maryland's Advocacy Network.

Personal Information
Name *
Organization (if applicable)
Mailing Address
City
State
Postal Code
Home Phone *
Work Phone
Fax
Email Address *
Please complete the following about yourself, I am a:
Dialysis Patient
Chronic Kidney Disease Patient (not on dialysis/not transplanted)
Transplant Recipient
Living Donor
Family member of a (check all that apply)
Donor Family Member (family member of a deceased donor)
Professional working with people with kidney disease
Other