Build Your Champion Toolkit
This takes about 10 minutes. Answer a few questions and we'll build everything you need — personalized templates, scripts, and a ready-to-send email. You don't have to figure out what to say. We've done that part for you.
About the patient
Tell us a little bit about the person you are advocating for
Patient Full Name
*
First Name
Last Name
What do you refer to them as? (e.g. if they're name is Joshua, do you call them Josh?)
*
Just a first name here
Patient Email
*
example@example.com
Patient Transplant Center Name
*
Type the name exactly as it appears on the paperwork
Patient NKR Microsite url (if they have one)
Leave this blank if they don't have one or if you're not sure
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About you
Tell us a little bit about you
Your Full Name
*
First Name
Last Name
Your Email
*
example@example.com
Your Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
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Let's build your toolkit
Tell us about the person you are championing
This person is my.... (e.g. husband/wife, sibling, friend, son/daughter, aunt/uncle, etc.)
*
Type one word here to describe your relationship
Complete this sentence: "After their transplant, [person's name] will finally be able to...
*
Be specific if you can — the more real this feels, the more it will move people.
Complete this sentence: "For everyone who loves [person's name], a transplant would mean more time to...
*
This helps people understand the ripple effect of a kidney donation
The patient I'm advocating for is aware of and okay with me completing this form. If not, please confirm they are aware and okay with this prior to submitting this form.
*
Yes, the patient is aware and okay with me completing this form
Build my Toolkit
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