Membership Consent Form

USE AND DISCLOSURE OF INFORMATION

We respect our member’s confidentiality and only use and disclose the minimum information necessary for your search for a living kidney donor.

Your Name and Contact Information

• Kidney Solutions may use and disclose certain demographic information in creation of promotional materials used in the search for a living donor.

Name and Contact Information of Your Transplant Hospital & Coordinator

• Kidney Solutions may identify this information in an effort to encourage potential living donors to schedule testing. I understand that some potential living donors may choose to be tested anonymously.

Your Photo / Video / Biography

• Kidney Solutions may use and distribute my Photo, Images, Video, Biography and other such items provided by me in creation of promotional materials used in the search for a living kidney donor.

Fundraising Activities

• Kidney Solutions may use my Photo, Images, Video, Biography and other such items provided by me to promote the non-profit organization to potential donors.

KIDNEY SOLUTIONS MEMBER AGREEMENT PLAN

This notice describes how our members will interact with Kidney Solutions, and what is expected of them. Please Review It Carefully!

• I agree to communicate with my assigned mentor a minimum of once (1 time) a month via text, email, or phone.
• I agree to actively search for a living donor by distributing the flyers that are received from Kidney Solutions, post the Kidney Solutions flyers on social media, and other tips discussed with me by my mentor.
• I agree to try to attend the online support group meetings whenever possible.
• I agree to notify Kidney Solutions if I receive an offer from the transplant hospital of a kidney or when I am transplanted
• I agree to refer all potential donors to Kidney Solutions so that Kidney Solutions can assist and mentor them throughout the process.
• I agree to notify Kidney Solutions of any changes in my personal contact information.