Note: Fields marked * are mandatory I Mr.Ms. agree to PLEDGE my SKIN, by Donating my SKIN after my Death. I grant permission for the recovery of my SKIN for purposes of Transplantation and Research. I would also like to donate my eyes YesNo Age* 123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899 Address* Telephone Mobile No.* Email of Donor* Family Doctor's Name Family Doctor's Telephone Next of Kin Name* Address* Email-Id Telephone Mobile* (*The next of kin should be above the age of 18) Once you are registered for Skin Donation, We shall send you Skin Donor Card, Magnetic Sticker and Skin Donor Badge.