Donate Life Ambassador Sign-Up

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Contact Information
Demographic Information
Emergency Contact Information

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Your Story
Pre-Transplant Candidate Information
Pre-Transplant Candidate Family Information
Donor Family Information
Living Donor Information
Transplant Recipient Information
Transplant Recipient Family Information

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Your Interests and Connections

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Donate Life Ambassador/Volunteer Confidentiality Agreement
I am a Donate Life Ambassador/volunteer at DCI Donor Services (DCIDS, Sierra Donor Services, Tennessee Donor Services, New Mexico Donor Services). As a volunteer of my time and abilities for DCIDS, I understand that I will be viewed by the community as a representative for organ, eye and tissue donation as well as DCIDS. I agree to conduct myself in a professional manner which will promote organ donation and the image of  DCIDS.

As a Donate Life Ambassador/volunteer, I acknowledge and agree to the following: 

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By entering your name below, you agree to adhere to the statements/guidelines expressed above.

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