KEEP Healthy Registration Form
IF YOU ARE COMPLETING THIS FORM AFTER 12:00 PM ON FRIDAY, AUGUST 23RD, YOU WILL NOT BE ON THE PRE-REGISTRATION LIST AT THE EVENT BUT WILL STILL BE ENTERED TO WIN A GIFT CARD.


The National Kidney Foundation is bringing our community kidney health screening program, KEEP Healthy, to Oklahoma City this year and we hope to see you there!

--- Monday, August 26th, 2019 at 3:30 pm - 6:30 pm
--- Midwest City YMCA - 2817 N Woodcrest Dr, Oklahoma City, OK 73110

--- Tuesday, August 27th, 2019 at 9:30 am - 12:30 pm
--- Rockwell Plaza YMCA - 8300 Glade Ave, Oklahoma City, OK 73132

Although pre-registration is not required, it is encouraged. By pre-registering you can skip much of the registration process on the day of the screening. Please provide some basic contact information. This information will not be shared with anyone. Everyone who pre-registers, will be entered to win a gift card upon completion of screening!

What to expect at the event: risk survey, blood pressure check, body mass index measurement (BMI), an opportunity to speak with a healthcare professional, free education materials, and for individuals at risk, an ACR urine test for albumin (a type of protein). Must be 17 years or older to participate. KEEP Healthy is a free program for participants.

General and Medical Volunteers Needed for this event. Visit www.kidney.org/KEEPvolunteerOKC for more information.

First Name: *
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Last Name: *
Your answer
Email Address: *
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What date would you like to reserve an appointment for a kidney health screening? *
Street Address: *
Please include apartment and/or suite number if applicable.
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City: *
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State:
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Zip Code: *
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Phone Number: *
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How did you hear about KEEP Healthy?
Please select all that apply.
Would you like to receive additional information from the National Kidney Foundation *
What is your preferred language? *
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