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Name
Gender
Organ i wish to donate
Address

Emergency Contact Person Details

Name
Address
NOTE:

My information may be shared with the National Organ and Tissue Transplant Organization (NOTTO) Registry* I understand that this pledge is for donation of my organs after my death and has NO FINANCIAL REWARDS.I understand that this is NOT A LIVING DONOR CARD and there is no such thing as a living donor card.

The information which you are entering in the above form is confidential and will be used only for purpose of organ donation and transplant processes and will not be shared/used for any other purpose.

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