Join the Donate Life Hawai'i Organ and Tissue Donor Registry

Yes! I wish to donate my organs, eyes and tissues to save or restore the lives of others.

Donor Information

Fields marked with an * are required.
* Please select one of the following:
* First Name:
Middle Name:
* Last Name:
* Gender
* Date of Birth:

Residential Address

* Street Address:
Address 2:
* City, State, Zip:
(Residents outside the state of Hawai'i visit
www.donatelife.net/register-now to register in your state.)

Contact Information

* Email Address:

Identification

Hawaii Driver License or State ID#:
(no dashes)

Limitations

If there are specific organs, eyes and tissue that you do not wish to donate, please state here. Please be brief, no narrative.

Additional Information

* How did you hear about us?
Registering in honor of:
  
  
Hawaii state law (Hawaii RUAGA ยง327-20) prohibits registry information from being used or disclosed with any company or government agency.