• Please correct the following items highlighted in yellow

Complete the form below to join millions of registered organ and tissue donors. By registering you consent to donate organs and tissues at the time of your death. Organs and tissues will be recovered for the purpose of transplantation and, in the event a donated organ or tissue cannot be used for transplant, an effort will be made to use the donation for research or education.

Questions about donation? View our Frequently Asked Questions.

Please fill out the form below to register as an organ, eye and tissue donor. By registering as a donor you consent to donate your organs, corneas and tissues at the time of your death. Organs and tissues will be recovered for the purpose of transplantation; however, in the event a donated organ or tissue cannot be used for transplant, an effort will be made to use the donation for research or education.

Registration Section:

Select One:

Add Myself to the Registry /Update My Record

Remove Myself from the Registry (The Nevada Donor Registry is an independent registry. If you registered at a DMV, you will need to apply for a new driver's license to update your record.)

Your Full Name (Enter legal name as it might appear on your government issued ID):

First Name:(Legal name as it might appear on your government issued ID)

Middle Name:

Last Name:(Legal name as it might appear on your government issued ID)

Gender:

Male

Female

Date of Birth: (mm/dd/yyyy)

Residential Address

Street Address:

Address 2:

City, State, Zip:

Contact Information:

Email Address:

(for confirmation of your donor registration)

Last four digits of your Social Security Number (for ID verification purposes only):

Last four SS#:(Last four digits of your Social Security Number for ID verification purposes only)

Limitations:

Limitations:(If there are specific organs and tissues you do NOT wish to donate, list them here. Also, indicate here if you do not wish your donation to be used for research or education.) If there are specific organs and tissues you do NOT wish to donate, list them here. Also, indicate here if you do not wish your donation to be used for research or education.

How did you hear about the Nevada Donor Registry?

Please Specify:

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Please Specify:

Registering in memory of:

Additional Information:

Donate Life Nevada is a collaboration of agencies committed to saving lives through organ, eye and tissue donation in Nevada. Member organizations include Nevada Donor Network, Donor Network West, Sierra Donor Services and Intermountain Donor Services. We are a proud affiliate of Donate Life America, a not-for-profit alliance committed to motivating the American public to register now as organ, eye, and tissue donors.

For further information, visit our website, www.DonateLifeNevada.org

Please click on the "Submit Information" button below to continue with the {{(model.procedure == 'enroll') ? 'registration ' : ''}}process.