Donate Life Dealer of the Year Award Registration Form

Donate Life New York State (NYS) proudly announces the Donate Life Dealer of the Year Award, a new program to recognize NYS Automobile Dealers Association (NYSADA) members for outstanding efforts in promoting organ, eye, and tissue donor enrollment, fundraising, and community engagement during Donate Life Month (April 2025).

Complete entry form by Friday, February 14, 2025 to enter the competition.

2025 Donate Life NYS Dealer of the Year Competition Registration Form

Register to compete in the inaugural Donate Life NYS Dealer of the Year Award Competition. Donate Life NYS will personally contact registered participants to further discuss the award competition details and provide resources that include educational and promotional materials to spread awareness about organ, eye, and tissue donation during April.

Dealership Information

Dealership Name(Required)

Dealership Address(Required)

Street Address Address Line 2 City State ZIP Code

Dealership Website(Required)

Dealership Phone(Required)

Contact Person

Contact Name(Required)

First Last

Contact Position/Title(Required)

Contact Email(Required)

Contact Phone(Required)

Agreement

By submitting this registration form, you are agreeing to participate and use the tracking URL provided by Donate Life NYS. You are also consenting to Donate Life NYS using your dealership’s name and activities for promotion in support of our mission to increase organ, eye, and tissue donation in NYS.

I agree to participate and use the tracking URL provided by Donate Life NYS.(Required)

I agree

I consent to Donate Life NYS using our dealership's name and activities for promotion(Required)

I agree

Digital Signature(Required)

Type your name to sign

Comments

This field is for validation purposes and should be left unchanged.