Share your story.

Everyone needs an ally and a supporter. We invite you to share your journey with us – the ups, the downs, the wins, and the losses because every case is different and your story helps increase awareness. We want you to feel comfortable in sharing your journey, so please share as much or as little as you would like. To share, please complete the form for submission and e-mail your photo(s) to info@lcrenalalliance.org.

P.O Box 63
Napavine, WA 98565

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Patient Diagnosis

Age of Onset

Relationship to Patient

Your Journey

Please tell us your story.

Signature

By typing your name into this box, you release the right to share your story within the website of www.lcrenalalliance.org and their social media. Your personal information will not be shared.

First Name

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