Enrollment Instructions

To become an organ, tissue and eye donor, please fill out the registration form below. Registration is a quick and easy process that only takes a few minutes. All the fields below are required information.

After submitting this information, we will mail you a consent form and a postage-paid return envelope. You can use the postage-paid envelope to return your consent form to us, which completes the registration process. According to New York State law, your registration is not effective until we receive your signed consent form.

First name: Required field
Last name: Required fieldRequired field
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City: Required field
State: Required field
Zip Code (5 digits only): Required field5 digit Zip Code only
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This grant-funded project promotes organ donation among young adults in New York State. The project is supported by Grant # D71HS09611 from the Health Resources and Services Administration (HRSA), Healthcare Systems Bureau, Division of Transplantation. Its contents are solely the responsibility of New York Alliance for Donation, Inc. and do not necessarily represent the official views of the HRSA.

Questions about this project can be addressed to Melanie Evans or Michael Stefanone.