New User Registration

Step 1. Registrant Information

Step 2. Confirmation

Kidney Smart Virtual Education at Eastern Time Zone

Tuesday, April 6, 2021 10:00 AM - 12:00 PM (EDT), WebEx

Take control of your kidney health by attending a no-cost Kidney Smart class led by a certified chronic kidney disease (CKD) educator. You'll learn about:
Chronic kidney disease and its causes Diet and nutrition Benefits of employment and managing insurance Treatment choices that may be available to you
Simply provide a few details about yourself and how we can reach you, and your Kidney Smart registration will be complete. If you are trying to register from a non-US location please email us at info@kidneysmart.org. We look forward to seeing you at this WebEx online class!

Location
This virtual course is led by an online educator. A link to the course will be sent via email. All class times are listed in Eastern Time Zone.

Registrant If registering for someone else please enter the participants information below

(* Field Required)

Select the option that best describes you:*

Participant First Name*

Participant Last Name*

Email Address*

(Confirmation and Reminders will be sent to email provided)

Mobile Phone Number*

(Please enter 10 digits only. Do not use special characters)

I would like to receive text message reminders

Text messages will be sent to provide reminders about Kidney Smart classes and appointments. Opt out any time by replying “STOP” to the text message or call 855-343-4951. Data and message rates will apply.Uncheck this box to opt-out of receiving text reminders.

Home Phone Number*

Date of Birth*

(mm/dd/yyyy)

Race/Ethnicity (select all that apply)*

Our goal is to ensure equal access to Kidney Smart education. All information will be used to help us improve outreach.

White

Hispanic

Black or African American

American Indian or Alaska Native

Asian

Native Hawaiian or Another Pacific Islander

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*Tell us about your health:*

How did you hear about our classes?

State/Province*

Postal Code*

Providing information through this page is strictly voluntary. By registering and submitting your information you are giving Kidney Smart permission to contact you. Any information you provide will be governed by our Web Usage Privacy Policy and Terms of Use. We are not collecting this information in our capacity as a health care provider, and any information we provide through our webiste is informational in nature and should not be considered medical or professional advice.

Healthcare Professionals: As a friendly reminder, Kidney Smart does not offer accreditation or certification for participation in classes.

I verify that this information is correct and agree with the terms and conditions.

Please click confirm button only one time to complete your enrollment.

Contact Information
Lana Jabari
Phone: (855) 343-4951
virtualeducator@kidneysmart.org

Instructor(s)
Jenifer Smith
Phone: (855) 343-4951