Donate Life Illinois

Donate Life Illinois is a coalition of agencies responsible for organ, tissue, eye, blood and marrow donation, as well as donor education and registration in Illinois. Learn about the many ways to get involved in our programs.

Donate Life Illinois provides donor registration drives, education programs and speakers at no charge.

Please note we can provide programs only for groups or audiences of 100 people or more.

To help us best meet your needs, please provide three options for dates and times for your registration drive, program or speaker.

Your Information

Your First Name

Your Last Name

City

County

Phone

Best time to call

E-mail

Where the program will be held

Name of company/organization

Contact Name

Phone

Address

Location of program (Suite #, cafeteria, etc.)

City

State

Zip

Program Information

Requested dates and times

First choice of date:

Time(s):

Second choice of date:

Time(s):

Third choice of date:

Time(s):

Type of Program

	Campus Program
	Donor registration table/Health Fair
	Workplace Program
	Speaker
	Special event/other

Audience (community, church congregation, nurses):

# of attendees expected:

Program topic/focus
(donor registry, general donation info, referral process, etc.):

Speaker requested

Yes No

If yes, length of presentation:

Speaker experience preferred
(donation professional, donor family, heart recipient, etc.):

Additional questions or information for us