Chronic-Kidney-Disease.net Health Leader Interest Form
**Please note: At this time, we are not actively recruiting additional patient leaders.**

Hello! Thank you for your interest in our contributor and/or moderator position(s) on Chronic-Kidney-Disease.net! Please complete the questionnaire below and if you seem like a good fit for this role, someone on our team will reach out to you. If you have any questions, please contact us at: contact@chronic-kidney-disease.net. Thank you!
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Email *
What is your first and last name? *
What is your email? *
What country do you live in? *
What are your preferred pronouns?
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Are you at least 18 years old? *
Which best describes your experience with chronic kidney disease? *
What position are you interested in? *
What is your social handle?
Briefly tell us a little about yourself and your journey with chronic kidney disease:
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In addition to chronic kidney disease, have you been diagnosed with any other chronic health conditions?
Why do you want to be a contributor and/or moderator for Chronic-Kidney-Disease.net?
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Have you blogged about your journey with chronic kidney disease anywhere? If so, please share the link below.
 *
How did you hear about this opportunity? *
I understand this form is just an interest form and someone will reach out to me if I might be a good fit as a health leader on Chronic-Kidney-Disease.net.
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