Enroll in the National Donor Registry

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Please Enter Only The Last Four (4) Digits of Your Social Security Number

SMS Text Communication Consent

Yes, I consent to receive SMS text messages from Mississippi Organ Recovery Agency.

By checking the box above, I consent to receive SMS text messages from Mississippi Organ Recovery Agency. I may receive messages in regard to Customer Care, confirmation of joining the Registry, confirmation of purchases, and notifications of received financial contributions. Reply STOP to opt-out. For assistance Reply HELP or call us at (800) 690-8878. Message and data rates may apply. Messaging frequency may vary. View our Privacy Policy and Terms of Service at https://msora.org/donate-life-mississippi-privacy-policy/.

Disclosure Statement

By submitting this registration, I affirm that I am the applicant described on this 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 REVISED MISSISSIPPI UNIFORM ANATOMICAL GIFT ACT (download). A document of gift, if not revoked by the donor before death, is irreversible and does not require the consent of any other person. It also authorizes any examination necessary to ensure the medical acceptability of the anatomical gift.

Agreement*

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 and research.

I have read the disclosure statement and wish to enroll in the Mississippi Donor Registry.

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Enroll in the National Donor Registry

Disclosure Statement

5 Things You Can Do

Register

Enroll in the National Donor Registry

Disclosure Statement

5 Things You Can Do

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