Note: Fields marked * are mandatory

I
Age*
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 would also like to donate my eyes
YesNo
Telephone
Mobile No.*
Address*
Email of Donor*
Family Doctor's Name
Family Doctor's Telephone
Next of Kin (The next of kin should be above the age of 18)
Name*
Email-Id
Address*
Telephone
Mobile*
Once you are registered for Skin Donation, We shall send you Skin Donor Card, Magnetic Sticker and Skin Donor Badge.