* 1. Address

* 2. Provide information about yourself. i.e. I am a kidney donor, transplant recipient, in need of a transplant, an advocate or other. If you were involved in a transplant please provide the date and for recipients did you receive a living or deceased donor kidney.

* 3. Are you currently or were you ever a member of a fraternal organization? If yes, which one?

* 4. Please specify if you are interested in speaking at a specific group such as Rotary, Kiwanis, Elks, Lions, Knights of Columbus, Masons, Moose Lodge. (Select 1 or more or add another name.) Also, briefly describe why you wish to speak to them.

* 5. Select the days of week you are able to speak. Most clubs meet for lunch some for breakfast.

* 6. If you are partnering with someone else, please provide their name and your relationship. Please ask them to fill out this form too,

* 7. I've listened to the recording of or participated in one of the live training sessions.

* 8. I have experience speaking to audiences of 25 or more people. If yes, provide some detail.

* 9. I own a laptop computer or I could borrow one for a presentation.

* 10. I own a computer projector or I could borrow one for a presentation.

* 11. Do you have questions? Feel free to ask them here or you could email them to: info@LKDN.org

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