Seeking home dialysis patients in 8 states for "People Like Us" fly-in to DC

Are you interested in telling your Members of Congress about home dialysis treatment options? If so, the National Kidney Foundation’s “People Like Us” is looking for candidates to participate in our next patient advocacy training/Capitol Hill “Fly In” being held September 22 - 23, 2009. At this time, we are ONLY seeking people from the following states and Congressional districts listed below. To find your Congressional district and Members of Congress, please go to this web site: http://www.govtrack.us/congress/findyourreps.xpd.

Arkansas (Representative Mike Ross - District 4)
Massachusetts (Representative Richard Neal - District 2)
Nevada (Representative Shelley Berkley - District 1)
New Jersey (Representative Bill Pascrell -District 8)
New York (Representative Joseph Crowley - District 7)
North Carolina (Representative Bob Etheridge - District 2)
Texas (Representative Sam Johnson - District 3 or Representative Kevin Brady - District 8)
Washington (Representative Jim McDermott - District 7)

Let’s help lawmakers understand and support home dialysis treatments. If you or someone you know would be interested in meeting with their members of Congress on September 22-23, 2009, in Washington, DC, please fill out the below “People Like Us” application form and fax to 212-689-9261 or e-mail to Erin Kahle at: erink@kidney.org. Only one or two candidates from each state will be chosen, so please send back your application ASAP. If you have any questions, please feel free to contact Erin at 1-800-622-9010, ext. 213.

Thank you for your interest!

Regards,
Tracy


NKF People Like Us Capitol Hill Advocacy Training/ Fly In
Program
Participant Application

ØWant to learn more about important issues related to chronic kidney disease (CKD), dialysis or organ/tissue donation or transplantation?

ØInterested in traveling to Washington, D.C. to tell the U.S. Congress about these issues and how they affect you?

ØWant to become an empowered People Like Us advocate?

If you answered yes to these questions, the National Kidney Foundation (NKF) invites you to apply to our People Like Us advocacy training/Capitol Hill Fly In program. People Like Us is the fastest-growing group of patient advocates dedicated to improving the lives of people affected by chronic kidney disease, donation and transplantation. Through our advocacy training and fly-in program, people like you are educated, empowered and encouraged to get involved and make a difference for yourself and others. The NKF covers the cost of travel, meals, lodging, and program materials. Individuals who would like to participate in the People Like Us Capitol Hill advocacy training program must show that they:

-Can Communicate - have a motivating story to share, show leadership qualities and exceptional verbal and/or written communication skills
-Are Courageous - able to travel to Washington, D.C. for advocacy training and participate in several meetings on Capitol Hill for at least a day and a half. ** Meetings on Capitol Hill with Members of Congress, requires walking about a mile or so throughout the day between offices. You must also be able to participate in at least (1) telephone conference call before you arrive in Washington, D.C.
-Are Committed to the Cause - willing to continue to work with the NKF nationally and locally on other programs, have an interest in staying involved on public policy, and willing to recruit other People Like Us members in your community

If you would like to be considered to participate in this program, please complete this application and return to: erink@kidney.org; or FAX to 212-689-9261. If you have questions, please call: 1-800-622-9010.

NKF People Like Us Capitol Hill advocacy training/Fly In Program Application

Name: __________________________________________________________________

Address: _____________________________________________________________________

City___________________________State_____________Zip code__________

E-mail address: ________________________________________________________________

Phone: _______________________________________________________________________

Available to travel and be in Washington D.C. for at least a day and a half?
Yes____No____

Do you work with a local NKF Division/Affiliate?Yes No
Who is your contact at the local office? ___________________________________

What kind of experience with advocacy do you have? ___________________________________



Do you have experience with state or federal legislative advocacy activities? (not required)
___Yes___No

What best describes you? (please check)

____Continuous ambulatory peritoneal dialysis (CAPD) - a manual form of peritoneal dialysis, with no machine
____Continuous cycling peritoneal dialysis (CCPD) - also known as Automated Peritoneal Dialysis (APD), a form of peritoneal dialysis using a cycler at night
____Conventional home hemodialysis - three-times-a-week hemo at home
____Daily home hemodialysis - short (2-3 hour) treatments, 5-6 days a week
____Nocturnal home hemodialysis - nightly 6-8 hour treatments, 3+ days a week

How long have you been receiving dialysis?______________

Best time/day to contact you?_________________________________________

Thank you for your interest in participating in the People Like Us advocacy training/Capitol Hill Fly-In program. We will be in touch with you soon. Even if you are not chosen to participate in this specific program, there are many other ways that you can become an empowered, educated People Like Us advocate. Please visit www.nkfpeoplelikeus.org to learn more about how you can advocate for yourself and others. Thank you again.

Tracy Fortson
Managing Director, Constituent Services
National Kidney Foundation
30 East 33rd Street
New York, NY 10016
Telephone: 212-889-2210 Ext. 285
tracyf@kidney.org
Be an advocate for yourself and others affected by chronic kidney disease, donation and transplantation by joining the National Kidney Foundation’s “People Like Us” empowerment movement - www.nkfpeoplelikeus.org