Enroll in the National Donor Registry

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

  • 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.
  • This field is for validation purposes and should be left unchanged.