REGISTRATION TILL DATE-63986

EYE DONOR (PLEDGE) REGISTRATION FORM

Mandatory Fields Marked With (*)
 
  * Name
 
  * Blood Group
 
  * Email
You will get e-Eye Donor (PLEDGE) card on this Email

 
  * Mobile Number +91   
 
  * State
 
  * City
 
  * Address
 
 
  * Pin Code
 
  *  Education
 
  * Occupation
 
  * Date of Birth
 
 
  * Gender
 
    I hereby agree that all the information provided by me is correct.
"I have willingly given the consent to donate my eyes after my death to any eye bank in india through this online form knowing that my name will be published on the website as a part of eye donation campaign and I will get only E-EYE DONOR (PLEDGE) CARD."