Share Your Story

Every story is unique, and we hope your story can help inspire others and increase awareness of kidney disease in Australia.

First Name *

Last Name *

Mobile Number *

Email *

Date of Birth

State/Territory *

Have you had a Kidney Transplant? If yes, what was the date of the transplant?

Tell us a little about your yourself? Hobbies, children, fur babies, family? *

Are you currently retired/working/studying? In what specialty? *

Tell us about your journey so far? Eg: Diagnosis, dialysis, transplant / waiting for a transplant *

What has been the hardest part of the journey so far?

How did you find out about Kidney Health Australia?

Have you taken part in any of our programs or services and have you found them helpful? *

What would you say to anyone who is considering fundraising for Kidney Health Australia?

If you have fundraised, what have you done and what's worked for you?

Are you happy to share some images? (you with friends/family, a day in the life, holiday, out and about, at home etc) *

Please upload any photo's you wish to share:

Are you interested in media opportunities should they arise?

I agree to the photo and video consent policy *

Without expectation of compensation or other remuneration, now or in the future, I hereby give my consent to Kidney Health Australia and its affiliates and agents, to use images and likeness and/or any interview statements in its fundraising appeals, publications, advertising or other media activities (including the Internet). This consent includes, but is not limited to:

a) Permission to interview, film, photograph, tape, or otherwise make a videoand/or record voices;
b) Permission to use quotes from the interview(s) (or excerpts of such quotes), film, photograph(s), tape(s) and/or recordings, in part or in whole, in its publications, in newspapers, magazines and other print media, on television, radio and electronic media (including the Internet), in theatrical media and/or in mailings for fundraising, educational and awareness.

By consenting to this policy, I agree that: The activity has been explained to me, and all of my questions have been answered to my satisfaction, I have read all of the information contained in this form in relation to the activity, I have been informed that participation in the activity is not mandatory and I give my consent freely.