As a loyal supporter of the American Kidney Fund, you make a critical difference to people who are fighting kidney disease. We're sending you this survey to learn how we can better serve you and strengthen your relationship with the American Kidney Fund. Your answers will remain completely confidential and will help us to provide you with information related to taxes, retirement income, and estate preservation that suits your interests.

1. Please tell us about yourself

 

*

*

*

 

 

Date of Birth:

 

 

 

What's this?

2.
Question - Not Required - Are you:





3.  


4.
Question - Not Required - Spouse's date of birth:




5.
Question - Not Required - Do you have:


6.
Question - Not Required - What is your connection to kidney disease?






7.
Question - Not Required - Which of the American Kidney Fund's programs and services are of most interest to you?







8.
Question - Not Required - Which of the following issues concern you? (please check all that apply)

9.
Question - Not Required - Please rate the importance of the benefit: Reduce income taxes





10.
Question - Not Required - Please rate the importance of the benefit: Reduce estate taxes





11.
Question - Not Required - Please rate the importance of the benefit: Minimize capital gains taxes





12.
Question - Not Required - Please rate the importance of the benefit: Increase income





13.
Question - Not Required - Please rate the importance of the benefit: Increase estate amount passing to heirs





14.
Question - Not Required - Please rate the importance of the benefit: Create a charitable legacy





15.


16.


17.
Question - Not Required - Would you consider including the American Kidney Fund in your will or estate plan?





18.
Question - Not Required - Have you included the American Kidney Fund in your:






19.

 

   Please leave this field empty