Note: Fields marked * are mandatory

    I

    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

    Age*

    Address*

    Telephone

    Mobile No.*

    Email of Donor*

    Family Doctor's Name

    Family Doctor's Telephone

    Next of Kin

    Name*

    Address*

    Email-Id

    Telephone

    Mobile*

    (*The next of kin should be above the age of 18)

    Once you are registered for Skin Donation, We shall send you Skin Donor Card, Magnetic Sticker and Skin Donor Badge.