CRN Local Chapter Affiliation

Welcome!

To complete the application, you'll need the following:

Chapter Chair contact information
Basic chapter data, such as number of members
Member roster saved in an Excel spreadsheet
Chapter's Rules & Regulations or Bylaws (if applicable)

Review the Guidelines for NKF-CRN Chapter Affiliation if this your first time affiliating or you need a refresher.

A red asterisk (*) indicates a required field. You will not be able to submit this application if a required field is blank.

To submit the form, click the "Submit" button at the bottom of the page. This only needs to be done once before leaving the site, not after filling in each section.

If you close your browser before clicking the "Submit and close" button, your answers will be lost. You will have to re-enter them on your next visit.

All Local Chapters must abide by the National Council on Renal Nutrition Rules and Regulations.

Chapter Name:*

Geographical Area Served:*

Does the Chapter collaborate with a local NKF office?:

YesNo

If so, please note NKF office name and primary contact:

Chairperson*

First NameLast Name

Chairperson Phone:*

Area CodePhone Number

Chairperson Email:*

This is the email that notifications will be sent to.

Current Membership Totals:

Dietitians:*

Students:*

Total:*

Frequency of Meetings:

Every monthTwice a yearFour times a yearOther

Does your Chapter encourage NKF national membership?

YesNoOther

Does chapter charge dues?

YesNo

If yes, membership dues amount:

Elections are held in:

Term of office begins in:

Length of Term:

Other Officers

Co-Chairperson

First NameLast Name

Email

example@example.com

Secretary

First NameLast Name

Email

example@example.com

Treasurer

First NameLast Name

Email

example@example.com

Other:

(Position, Name, Email)

Required: Chapter's Membership Roster

Upload a copy of your Local Chapter Membership Roster, as a Microsoft Excel document. Click here to download a template.

Please name your document in the following format: "[ChapterName]Roster.xls".

*Roster should include the following:

First and last names
appropriate credentials (RD, PhD, etc.)
preferred mailing address
e-mail address
If known, please indicate if the local member is also an NKF-CRN national member (not required).

Click the "Browse" button to find the appropriate file on your computer. Clicking "Save and Continue" will upload the file. The file names CANNOT exceed 50 characters. You may upload over a previous document. Please do not change the filename.

Roster:*

By adding your initials to each statement below, the Chapter is affirming it has read and accepted NKF's policies. Read the policies here.

We agree to meet no less than 2 times per year (example: conference calls, networking activities, etc.).

We agree to work with NKF HQ or our local office in the management of our finances.

We agree to not hold an independent bank account for any local chapter finances.

We agree to work directly with the National NKF CE office, and abide by NKF's CE policies in the planning and implementation of any CE-accredited programs.

We agree to adhere to NKF's use of logos and branding policies.

We agree to collaborate with local NKF office(s) to develop, promote, and execute local patient and professional programming.

We agree to promote National NKF Membership among local chapter members

We agree to positively represent the National Kidney Foundation and the Council on Renal Nutrition.

We agree to adhere to all National CRN Rules and Regulations (official document above).

Statement of Support:

I agree to support the NKF Council on Renal Nutrition, to accept their Rules and Regulations, and to abide by their guidelines for affiliation.

*

I have read the affiliation policies and agree with the above statement

Your Name:*

First NameLast NameCred

Thank you very much for your time, effort, and support!

LOCAL CHAPTER AFFILIATION FORM

Welcome!

Other Officers

Required: Chapter's Membership Roster

Attestation for Operation as an Affiliated Local Chapter

Statement of Support:

I agree to support the NKF Council on Renal Nutrition, to accept their Rules and Regulations, and to abide by their guidelines for affiliation.