The gold standard for obtaining patient input for biomedical research once was ensuring a representative sample of the population with the disease. Concurrently, in the past several years there has been a growing movement to more deliberately and equitably include historically underrepresented and underserved communities in R&D activities. As this movement has evolved, patient organizations are transforming their approaches to meet the demand for representative, equitable, and diverse patient engagement in R&D activities. In this session, we will hear from patient foundation leaders about the practical challenges of pursuing diverse and representative patient engagement and where there are lessons learned and opportunities that are applicable to others pursuing more diverse and inclusive research activities.