Request for Custom Microsite Posters

Thank you for choosing to participate in the National Kidney Registry’s microsite program! When you have updated your microsite from starter to custom status, you are eligible to receive 25 custom posters to be shipped to you at no charge. These posters are 8.5 x 11″ and are full color. The posters will be generated with your name and photograph along with your microsite web address and QR code to it.

Contact Us Posters

Microsite Patient Info

Patient First Name *

Please provide patient name as you would like it to appear on the flyers.

Patient Last Name *

Microsite URL *

(i.e. nkr.org/AW222)

I am seeking a living donor for: * KidneyLiver

Are you a military veteran? * YesNo

Email

We will only email you if there is an issue with your request.

Confirm Email

Please generate my posters in: * EnglishSpanish

Shipping Information

If flyers are being shipped to someone other than the microsite patient, please include that information below.

Ship to:

Ship to:

First Name

First Name

Last Name

Last Name

Relationship to microsite patient

Address *

Address

Address

Address

City

City

State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

State/Province

Zip/Postal

Zip/Postal

Please ensure that you provide accurate shipping information for your print request.

Poster Selection *

Option 1

Option 2

Option 3

Option 4

Option 5

You may only select one style optimization. Custom requests for changes to these templates are not accepted.

Poster Selection (Spanish) *

Option 1

Option 2

Option 3

Option 4

Option 5

You may only select one style optimization. Custom requests for changes to these templates are not accepted.

Image Upload (optional)

Drop a file here or click to upload Choose File

Maximum file size: 67.11MB

You are not required to upload a photo. If you do not upload a new file, we will use the primary photo from your microsite.
Please note:  If the image provided is blurry or otherwise poor quality, a proof of your poster will be emailed to you for approval before it is printed and shipped.

Submit

If you are human, leave this field blank.