New York State Donate Life Registry Enrollment Form

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.

Already registered? Click here to access your registration.

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First Name

Middle Name

Last Name

Date of Birth

Mailing Address*

City

State

Zip

E-mail Address

Identity Verification Information

Please provide your NYS DMV# or the last 4 digits of your Social Security Number for identity verification purposes.

NYS DMV ID# Enter the last 4 digits of my social security number instead

What is this?

Information entered into the enrollment form above is submitted to the New York State Donate Life Registry (Registry). Using the information provided on the form, the Registry uses third party identity verification to confirm the identity of every person that enrolls through this website. Neither the Registry nor the third-party verifier keeps a record of the last four digits of the social security number or answers to the multiple-choice questions. Once the enrollee's identity is confirmed, the enrollment proceeds and the enrollee will be brought to their donor profile indicating that their registration is successful. On this page enrollees have an opportunity to edit or update their profile information, limit their donation and create an account. If the Registry is unable to confirm an enrollee's identity, they are given an opportunity to print out a form that can be submitted by mail or email.

By clicking submit, I accept the Terms and Conditions of this website and I am indicating my consent to enroll in the Registry. I understand that by enrolling in the Registry, I am giving legal consent to the donation of my organs, tissues and eyes in the event of my death. I authorize access to the information as needed for the administration of the Registry and to federally regulated organ procurement organizations, New York State licensed tissue and eye banks, and entities formally approved by the NYS Commissioner of Health at or near the time of my death.