BECOME A DONOR YES! I wish to donate my organs, tissues, and eyes to save or enhance someone's life through transplantation. Name * First Name Last Name Mother's Maiden Name * First Name Last Name Driver's License Number / ID # * Most Recent Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Date of Birth * MM DD YYYY Gender * Male Female Other Ethnicity Black / African American White Hispanic Asian American Indian / Alaska Native Pacific Islander Phone * (###) ### #### Email * Terms & Conditions * By submitting this registration, I affirm that I am the applicant described on the application and that the information entered herein is true and correct to the best of my knowledge. This registration will serve as a document of gift as outlined in the Georgia Uniform Anatomical Gift Act. A document of gift, not revoked by the donor before death, is irreversible and does not require the agreement of any other person. It also authorizes any examination necessary to ensure the medical acceptability of the anatomical gift. Yes, I accept the terms and Conditions. Thank you!
