Share your story with the American Kidney Fund
Sharing your experiences inspires, uplifts and spread awareness to others while supporting AKF's mission.
Why we are asking you to share your story
Stories are powerful. They can show the reality of what people living with kidney disease, their caregivers and loved ones face and what your hopes are for the future in ways that resonate with policymakers, advocates, donors and others who are part of the kidney community and/or can create lasting change for them.
Please submit this form to grant the American Kidney Fund permission to use your stories, photographs, video, audio or other media for its organizational and mission-oriented purposes including, but not limited to, fundraising and advocacy efforts. For the purposes of this consent form, "story" refers to all media types.
Your rights to your story:
- You may see how your story will be used.
- You may request updates to your story.
- You may revoke your consent at any time. To do so, email mdeeley@kidneyfund.org. After you revoke consent, we will not use your story in communications from that point forward. We will do our best to retract already published images and stories, but please understand that we may not be able to remove all such instances.
- You may contact us at any time at mdeeley@kidneyfund.org with any questions or concerns.
By signing this release form, you are granting the American Kidney Fund the exclusive right to use, adapt, modify, reproduce, distribute, translate, promote and publicly display your shared story in perpetuity.
This includes, without limitation, the ability to reproduce or distribute, in whole or in part, in hard or electronic copy, including in print, CD, DVD, broadcast and in any other medium now known, including on websites, videos and on other public online forums (email, social media platforms, newsletters, etc.), or hereafter invented.
By signing this release form, you acknowledge that the American Kidney Fund owns all content and works created or collected by the American Kidney Fund and/or by its agents, successors and/or assigns, that use, are based on or incorporate the content or my Personal Information. (Your Personal Information — which means name, appearance, likeness, statements and other limited biographical information — may be used, adapted, modified, reproduced, distributed and publicly displayed by the American Kidney Fund in connection with the story in any medium now known or hereafter invented.)
If you understand, agree and consent, please provide the information below, sign your full name and include the date.