Gift of Life, the Michigan organ and tissue donation

Gift of Life Michigan
3861 Research Park Drive
Ann Arbor, MI 48108
800-482-4881

*Required Form Fields

* Name:

*Day Phone:

Evening Phone:

*Email:

Company/Organization/School:

Street Address:

UPS will not deliver to PO Boxes - include Street address if requesting supplies.

City:

State:

Zip:

How did you hear about Gift of Life?

I am a:

Check all that apply:

I would like to request supplies/handouts for an event or presentation.

I would like to request a volunteer to speak to my group or to
staff an information table at my event.

Yes, contact me in regard to volunteering.

Please tell us about your program, so we can do our best to fulfill your request:
Event/Program Date:
Time(s):	From to
City/Location of event
Number of people anticipated:
Event Type:

Supplies Requested (please list quantities): Please be sure your contact information is filled out at the top of this page, including a street address (UPS will not deliver to PO Boxes).
Michigan Organ Donor Registry brochures
Pens to sign Donor Registry brochures at event
Volunteer Requests: We cannot guarantee a volunteer presence, but we will make every effort to secure support for your event. We will contact you directly for detailed information on your volunteer request.

*Subject:

Comments/requests