Anatomical Donation: The Legacy of a Lifetime™
LifeLegacy Foundation: Anotomical Donation: The Legacy of a Lifetime


read more...

FOR POTENTIAL DONORS

Welcome

About Us

Making a Choice

Becoming a Donor

News


Testimonials


Resources

Contact Us



Donate Life

Choosing Anatomical Donation

Information Request Form

To receive a LifeLegacy Foundation donation packet, please complete this form and submit.

NOTE: If you are notifying us of the passing of a potential donor, please call 888-774-4438 and ask to speak with a Donor Coordinator. Please do not use this form for this notification.

Information Request Form

Name:

Address 1:

Address 2:

City:

State:

Zip Code:

Telephone Numbers (enter each on a separate line):

Fax Number:

Email Address:


   

How would you prefer to receive the information?

Email
Fax
Mail

   

Is this information for yourself or someone else?

Myself
Someone else

   

If someone else, what is the name and relationship to you?

Name:

   

Relationship:

   

Comments or specific questions:

   

How did you learn about us?

   

We look forward to partnering with you and creating the legacy of a lifetime. If you have any additional questions, please call 520-575-5200 or 888-774-4438.

   

 

 
LifeLegacy Foundation is a federally-approved 501(c)(3) nonprofit charity.