Donating-New York Style Registration

Join NYKidney for a Living Donor Kidney Transplant virtual workshop? Are you interested in becoming a living donor or have questions about the donation process? Join us to learn best strategies to help you become a living donor. Please register below:

Question Title

* 1. Contact Information

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

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

Question Title

* 3. Are you a...

Patient

Caregiver

Other (please specify)

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.

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

Question Title

* 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)

Donating-New York Style Registration