Living it Up-New York Style Registration

Living it Up Registration

Join NYKidney for a Living Donor Kidney Transplant virtual workshop. Do you need a kidney transplant and are on a transplant list in New York State? Join us to learn best strategies to help you find a living donor. Please register below:

Question Title

* 1. Contact Information

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. Which session would you like to attend? (Specify Date)

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* 3. Are you a...

Patient

Caregiver

Other (please specify)

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* 4. Have you or a loved one started dialysis? If yes, which dialysis center are you visiting?

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* 5. Are you or a loved one on a transplant list? If yes, which transplant center are you listed with?

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* 6. Please provide your education level.

Less than high school

High school diploma or equivalent

Some college, no degree

Postsecondary non degree award

Associate degree

Bachelor's degree

Master's degree

Doctoral or professional degree

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* 7. Ethnicity/Race

White or Caucasian

Black or African American

Hispanic or Latino

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Another race

I prefer not to answer

Other (please specify)

Living it Up-New York Style Registration

Living it Up Registration

Question Title

* 1. Contact Information

Question Title

* 2. Which session would you like to attend? (Specify Date)

Question Title

* 3. Are you a...

Question Title

* 4. Have you or a loved one started dialysis? If yes, which dialysis center are you visiting?

Question Title

* 5. Are you or a loved one on a transplant list? If yes, which transplant center are you listed with?

Question Title

* 6. Please provide your education level.

Question Title

* 7. Ethnicity/Race

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* 8. Please provide your age

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* 9. How did you hear about the Living it Up workshop?