Sign up online as an organ, eye and tissue donor in just a few minutes. By completing the form below, you can save the lives of up to eight people and enhance the lives of countless others.
* = required field
Please provide your NYS DMV# or the last 4 digits of your Social Security Number for identity verification purposes.
Information entered into the enrollment form above is submitted to the New York State Donate Life Registry (Registry). Using information provided on the form, the Registry uses third-party identity verification sources to confirm the identity of every person that enrolls through this website. The last four digits of the social security number and answers to the multiple-choice questions are used for identity verification purposes only and are not retained. Once the identity is confirmed, the enrollee is brought to a confirmation page where they may update their information and make changes to their donation. If the enrollee’s identity cannot be verified, they are given an opportunity to print and sign a form to submit by mail or email.
By clicking the Submit button, I affirm under penalty of law that I am the individual on the above form, I consent to the submission of this information to verify my identity and enroll in the Registry, and I accept the Terms and Conditions of this website. I understand that I am electronically signing this Registry enrollment form, and this electronic signature is the legal equivalent of my handwritten signature. I also understand that if my above registration information cannot be verified, I will be unable to join the Registry through this document.