Thank you for registering to attend the AAKP National Patient Meeting in St. Petersburg, FL (June 8-10, 2018). Please take a few moments to complete the information below, this allows AAKP to finalize your registration. Please contact AAKP at (800) 749-2257 with any questions. 

*1.Address(Required.)

Name *

Company (if applicable)

Address *

Suite/Apt

City/Town *

State *

AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming

ZIP/Postal Code *

Email Address *

Phone Number *

2.Please share your race/ethnicity:

African American

American Indian or Alaskan Native

Asian

Hispanic or Latino

Native Hawaiian or other Pacific Islander

White

Other (please specify)

3.Please select what best describes you:

CKD/Pre-Dialysis Patient (not yet on dialysis)

In-Center Dialysis Patient

Home Hemodialysis Patient

Peritoneal Dialysis Patient

Transplant Recipient

Family Member/Friend/Caregiver

Healthcare Professional (physician, nurse,social worker, dietitian, etc.)

4.Are you a first-time meeting attendee?

Yes

No

5.Will you require in-center dialysis during the meeting?

Yes

No

6.Will you be shipping Home Hemodialysis or Peritoneal Dialysis supplies to the hotel?

Yes

No

7.Do you have any of the following risk-factors and/or co-morbid conditions for kidney disease? (Please select all that apply)

Anemia (decreased amount of red blood cells in the blood)

Bone Disease

Cancer

Diabetes

Heart Disease

Hypertension (high blood pressure)

Other (please specify)

Please complete the last two questions which indicate your Lunch with the Expert table choices. Tables are assigned on a first-come, first-reserved basis. Should your table choices not be available, an AAKP staff personnel will contact you to select another table.

8.Please select your top three Lunch with the Expert table topics (Friday, June 8)

Friday - Lunch with the Experts

Table Choice 1

Table 1 How Can I Slow the Progression of Kidney Disease?Table 2 Learn How to Become a Living DonorTable 3 Choosing or Changing My Kidney Treatment OptionsTable 4 Overcoming Barriers to TransplantationTable 5 Pre-emptive Transplant: Is It Possible to Avoid Dialysis and Receive a Kidney Transplant?Table 6 Understanding the Risk of Skin Cancer Post-TransplantTable 7 Lunch with the AAKP PresidentTable 8 Learn How to Become an Effective Patient Advocate: Locally & NationallyTable 9 Caregivers Connect: Sharing the Ups and DownsTable 10 Managing My MedicationsTable 11 Coping with a Chronic IllnessTable 12 Becoming Active in Your Local CommunityTable 13 Clinical Trials: Getting Involved & Understanding Your Rights & ResponsibilitiesTable 14 Patient Opportunities for Financial AssistanceTable 15 How Do I Start a Local Support Group?Table 16 Cooking Kidney-FriendlyTable 17 Understanding and Managing GoutTable 18 Emergency Preparedness: The Importance of Having a PlanTable 19 The Benefits of Exercise in Kidney DiseaseTable 20 Fighting the Fatigue: Understanding & Managing Anemia in Kidney DiseaseTable 21 Is Home Hemodialysis Right for Me?Table 22 Is Peritoneal Dialysis Right for Me?Table 23 Managing My Care: Understanding Self-CannulationTable 24 KidneyWorks: Employment and Kidney DiseaseTable 25 How to Find a Living Donor: Sharing Your Story

Table Choice 2

Table 1 How Can I Slow the Progression of Kidney Disease?Table 2 Learn How to Become a Living DonorTable 3 Choosing or Changing My Kidney Treatment OptionsTable 4 Overcoming Barriers to TransplantationTable 5 Pre-emptive Transplant: Is It Possible to Avoid Dialysis and Receive a Kidney Transplant?Table 6 Understanding the Risk of Skin Cancer Post-TransplantTable 7 Lunch with the AAKP PresidentTable 8 Learn How to Become an Effective Patient Advocate: Locally & NationallyTable 9 Caregivers Connect: Sharing the Ups and DownsTable 10 Managing My MedicationsTable 11 Coping with a Chronic IllnessTable 12 Becoming Active in Your Local CommunityTable 13 Clinical Trials: Getting Involved & Understanding Your Rights & ResponsibilitiesTable 14 Patient Opportunities for Financial AssistanceTable 15 How Do I Start a Local Support Group?Table 16 Cooking Kidney-FriendlyTable 17 Understanding and Managing GoutTable 18 Emergency Preparedness: The Importance of Having a PlanTable 19 The Benefits of Exercise in Kidney DiseaseTable 20 Fighting the Fatigue: Understanding & Managing Anemia in Kidney DiseaseTable 21 Is Home Hemodialysis Right for Me?Table 22 Is Peritoneal Dialysis Right for Me?Table 23 Managing My Care: Understanding Self-CannulationTable 24 KidneyWorks: Employment and Kidney DiseaseTable 25 How to Find a Living Donor: Sharing Your Story

Table Choice 3

Table 1 How Can I Slow the Progression of Kidney Disease?Table 2 Learn How to Become a Living DonorTable 3 Choosing or Changing My Kidney Treatment OptionsTable 4 Overcoming Barriers to TransplantationTable 5 Pre-emptive Transplant: Is It Possible to Avoid Dialysis and Receive a Kidney Transplant?Table 6 Understanding the Risk of Skin Cancer Post-TransplantTable 7 Lunch with the AAKP PresidentTable 8 Learn How to Become an Effective Patient Advocate: Locally & NationallyTable 9 Caregivers Connect: Sharing the Ups and DownsTable 10 Managing My MedicationsTable 11 Coping with a Chronic IllnessTable 12 Becoming Active in Your Local CommunityTable 13 Clinical Trials: Getting Involved & Understanding Your Rights & ResponsibilitiesTable 14 Patient Opportunities for Financial AssistanceTable 15 How Do I Start a Local Support Group?Table 16 Cooking Kidney-FriendlyTable 17 Understanding and Managing GoutTable 18 Emergency Preparedness: The Importance of Having a PlanTable 19 The Benefits of Exercise in Kidney DiseaseTable 20 Fighting the Fatigue: Understanding & Managing Anemia in Kidney DiseaseTable 21 Is Home Hemodialysis Right for Me?Table 22 Is Peritoneal Dialysis Right for Me?Table 23 Managing My Care: Understanding Self-CannulationTable 24 KidneyWorks: Employment and Kidney DiseaseTable 25 How to Find a Living Donor: Sharing Your Story

9.Please select your top three Lunch with the Expert table topics (Saturday, June 9)

Saturday - Lunch with the Experts

Table Choice 1

Table 1 How Can I Slow the Progression of Kidney Disease?Table 2 Becoming a Living Donor: What Your Need to Know Pre & Post SurgeryTable 3 Choosing and Changing My Kidney Treatment OptionsTable 4 Dental Issues in Kidney DiseaseTable 5 The Importance of Managing Your High Blood PressureTable 6 The Importance of Managing Your DiabetesTable 7 Understanding and Managing GoutTable 8 Advancements in TelemedicineTable 9 Caregivers Connect: Sharing the Ups and DownsTable 10 Managing My MedicationsTable 11 Coping with a Chronic IllnessTable 12 The Importance of Vaccinations in Kidney DiseaseTable 13 Getting Involved in Patient-Centered Research ProjectsTable 14 Fistula First: Understanding Your Dialysis Access OptionsTable 15 Food Facts: Understanding the Food Nutrition LabelTable 16 Cooking Kidney-FriendlyTable 17 Dining Out While on DialysisTable 18 Food Safety for Kidney Transplant PatientsTable 19 The Benefits of Exercise in Kidney DiseaseTable 20 Fighting the Fatigue: Understanding & Managing Anemia in Kidney DiseaseTable 21 The Benefits of Home HemodialysisTable 22 The Benefits of Peritoneal DialysisTable 23 How to Use Social Media to Effectively Raise Awareness of Kidney DiseaseTable 24 CMS Dialysis Facility Compare Five Star RatingTable 25 Understanding Acute Kidney Injury

Table Choice 2

Table 1 How Can I Slow the Progression of Kidney Disease?Table 2 Becoming a Living Donor: What Your Need to Know Pre & Post SurgeryTable 3 Choosing and Changing My Kidney Treatment OptionsTable 4 Dental Issues in Kidney DiseaseTable 5 The Importance of Managing Your High Blood PressureTable 6 The Importance of Managing Your DiabetesTable 7 Understanding and Managing GoutTable 8 Advancements in TelemedicineTable 9 Caregivers Connect: Sharing the Ups and DownsTable 10 Managing My MedicationsTable 11 Coping with a Chronic IllnessTable 12 The Importance of Vaccinations in Kidney DiseaseTable 13 Getting Involved in Patient-Centered Research ProjectsTable 14 Fistula First: Understanding Your Dialysis Access OptionsTable 15 Food Facts: Understanding the Food Nutrition LabelTable 16 Cooking Kidney-FriendlyTable 17 Dining Out While on DialysisTable 18 Food Safety for Kidney Transplant PatientsTable 19 The Benefits of Exercise in Kidney DiseaseTable 20 Fighting the Fatigue: Understanding & Managing Anemia in Kidney DiseaseTable 21 The Benefits of Home HemodialysisTable 22 The Benefits of Peritoneal DialysisTable 23 How to Use Social Media to Effectively Raise Awareness of Kidney DiseaseTable 24 CMS Dialysis Facility Compare Five Star RatingTable 25 Understanding Acute Kidney Injury

Table Choice 3

Table 1 How Can I Slow the Progression of Kidney Disease?Table 2 Becoming a Living Donor: What Your Need to Know Pre & Post SurgeryTable 3 Choosing and Changing My Kidney Treatment OptionsTable 4 Dental Issues in Kidney DiseaseTable 5 The Importance of Managing Your High Blood PressureTable 6 The Importance of Managing Your DiabetesTable 7 Understanding and Managing GoutTable 8 Advancements in TelemedicineTable 9 Caregivers Connect: Sharing the Ups and DownsTable 10 Managing My MedicationsTable 11 Coping with a Chronic IllnessTable 12 The Importance of Vaccinations in Kidney DiseaseTable 13 Getting Involved in Patient-Centered Research ProjectsTable 14 Fistula First: Understanding Your Dialysis Access OptionsTable 15 Food Facts: Understanding the Food Nutrition LabelTable 16 Cooking Kidney-FriendlyTable 17 Dining Out While on DialysisTable 18 Food Safety for Kidney Transplant PatientsTable 19 The Benefits of Exercise in Kidney DiseaseTable 20 Fighting the Fatigue: Understanding & Managing Anemia in Kidney DiseaseTable 21 The Benefits of Home HemodialysisTable 22 The Benefits of Peritoneal DialysisTable 23 How to Use Social Media to Effectively Raise Awareness of Kidney DiseaseTable 24 CMS Dialysis Facility Compare Five Star RatingTable 25 Understanding Acute Kidney Injury