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7,937,017 New Yorkers have joined the NYS Donate Life Registry

Donate Life Rx Registration Form

Donate Life New York State (NYS) and the NYS Pharmacy Community are uniting for Donate Life Month to increase organ, eye, and tissue donor registrations and support lifesaving programs. This April, pharmacies, universities, and professionals across NYS will participate in the inaugural Donate Life Rx campaign.

Complete the registration form below by Friday, February 14, 2025 to participate.

2025 Donate Life Rx Campaign Registration Form

Register to participate in the inaugural Donate Life Rx Campaign. Donate Life NYS will personally contact registered participants to further discuss the campaign details, and provide resources that include educational and promotional materials to spread awareness about organ, eye, and tissue donation during April.

Organization Information

Organization Address(Required)

Contact Person

Contact Name(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 organization’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 consent to Donate Life NYS using our organization's name and activities for promotion(Required)
Type your name to sign
This field is for validation purposes and should be left unchanged.