Fields marked with an ( * ) are must-fill
To print the page (print before you Click the
Click the 'printer friendly' link at the bottom of the page and Click the
'print page' button on the right upper corner to print.
Use the 'SUBMIT' button to submit the registration for processing.
wish to register myself (or a dependent
minor) as a tissue donor with the NICHD Brain and Tissue Bank for Developmental Disorders at the
University or Maryland, Baltimore. Completion of this registration form provides
important formation needed to coordinate tissue recovery in the event of the
death of the donor. After the Brain and Tissue Bank
receives this registration form, you will receive a packet containing Anatomical
Gift Act forms and Access to Medical Records forms as well as other information.
(Please complete both Part One
and Part Two.)
Press to clear all form information and start over!
here to send the information you have entered to the Brain and Tissue bank.