First name

Last name

Email

Phone

Street 1

Street 2

City

State

Zip code

Are you currently or have you ever been an AKF grant recipient?

Are you interested in advocating for a rare disease? If so, which disease?

Please tell us why you'd like to join our annual Kidney Action Summit.

Please tell us about your (or a loved one's) experience with kidney disease.

If you are currently or have been on dialysis, tell us how dialysis has impacted or changed your life?

Are you involved in advocacy on the state level?

Are you able to travel to Washington, D.C. for two to three nights and participate in events from May 15-17?

Will you need accommodations for any mobility impairments?

Are you willing to participate in interviews with the media? This may include radio, television, online, and print outlets (i.e., newspapers, magazines).

If you use social media, please tell us any of your social media names/handles.

How comfortable are you with social media?

Have you applied to attend AKF's Kidney Action Summit in previous years?

How did you hear about this year's Kidney Action Summit?

Please tell us any other information that you think would be helpful when considering your application.

AKF spotlights

Apply for the 2023 Kidney Action Summit

Join the 37 Mile Challenge today!

View the 2023 AKF Living Donor Protection Report Card

New AKF microsite focuses on disparities in kidney disease

Join the 37 Mile Challenge today!

View the 2023 AKF Living Donor Protection Report Card

New AKF microsite focuses on disparities in kidney disease