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Are you ready to be a legend?

One donor can save or heal up to 83 people, and the need is greater than ever. Today, more than 100,000 people are waiting for a lifesaving call that a donated organ is available. A transplant means the difference between life and death – it means more birthdays, anniversaries, weddings and children. It means more everyday joys like walking without losing breath, going out of town without missing dialysis or living without a connection to a heart monitor.

To learn more about donation and transplantation, visit DonateLifeIndiana.org.

Donor Registration Form

* Required field.

First Name *

Middle Name

Last Name *

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Date of Birth *

Last 4 of SSN *

Sex * MF

Address Line 1 *

Address Line 2

City *

State * ALAKAZARCACOCTDEFLGAHAIDILINIAKSKYLAMDMEMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

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Email Address *

How Did You Hear About Us? * Ambassador ProgramBillboardClauson-Marshall RacingCountry Music Radio StationFriend or familyHigh Limit RacingNews storyRadio commercialRyan NewmanSocial mediaSocial media influencerTent or boothTV commercialOther

Other Source *

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Privacy: Your status as a registered organ, tissue and eye donor will be protected as personal health information, and the security of your personal information is of the utmost importance. We will not share your registration status or personally identifiable information about you with other companies, agencies or individuals except as directly related to the donation process or as required by law. If you have questions about this policy, please contact us at 317.222.3434.

This registration is a binding, legal document of gift. You affirm the information provided is accurate. You agree upon death to donate all eligible organs and tissues for transplant. You can remove your registration or specify more detailed donation preferences at any time at RegisterMe.org.

The national Donate Life Registry is managed by Donate Life America.