By submitting this registration, I affirm that I am the applicant described on this application and that the information entered herein is true and correct to the best of my knowledge.
This registration will serve as a document of gift as outlined in THE REVISED MISSISSIPPI UNIFORM ANATOMICAL GIFT ACT (download). A document of gift, if not revoked by the donor before death, is irreversible and does not require the consent of any other person. It also authorizes any examination necessary to ensure the medical acceptability of the anatomical gift.
Donate Life Mississippi does not collect any personal information about visitors to this Site (such as names, addresses, driver license numbers, telephone numbers or e-mail addresses) unless visitors provide such information voluntarily. If visitors do not want their personal information compiled, such information should not be submitted through this website. If personal information is submitted, such information may be used as follows:
- Information submitted by visitors wishing to be organ, tissue or eye donors will be added to the Donate Life Mississippi Organ, Tissue and Eye Donor Registry (the "Registry") and utilized for Registry purposes as defined under Mississippi law;
- Information submitted by visitors may be stored, as permitted by Mississippi law, and analyzed to evaluate the effectiveness of efforts made to increase the number of donors; and
- Information submitted may be used to contact individuals and/or their family members for Registry purposes.
Donate Life Mississippi will not sell, rent or market personal information to third parties. All information submitted through the Registry will be kept confidential at all times, except to the extent necessary for organ, tissue and eye donations to be achieved in accordance with Mississippi law.
Donate Life Mississippi may collect technical information related to visitors such as the type of internet browser and/or computer operating system being utilized as well as the domain name of any website visitors utilize to link to this Site. Such technical information will not include the personal information discussed above.
If you have any questions about the Registry or anything discussed herein, please contact Donate Life Mississippi at: firstname.lastname@example.org.