I Mr./Mrs. (required)*
agree to pledge my skin, by donating my skin after my death. I grant permission for the recovery of my skin for purposes of transplantation and research.

I also would like to Donate my
Eyes         Organs     

Date of Birth

Mobile Number*

Email*

Address

Name of Next of Kin**

Kin's Relationship

Mobile Number

"You Pledging Skin Today means You are destined to Save Someone's Life One Day."

 
*Mandatory Fields

**Next of Kin needs to be Close relative, over 18 years of age