---------------------------------------------------------------- UNIFORM DONOR CARD I______________________________have spoken to my family about organ and tissue donation. I wish to donate the following: ____Any needed organs and tissue. ____Only the following organs and tissue:_____________________ Signature________________________________Date_________________ Date The following people have witnessed that I have chosen to pledge the gift of life: Witness_____________________________ Witness_____________________________ Place this portion in your wallet. ---------------------------------------------------------------- UNIFORM DONOR CARD I______________________________have spoken to my family about organ and tissue donation. I wish to donate the following: ____Any needed organs and tissue. ____Only the following organs and tissue:_____________________ Signature________________________________Date_________________ Date The following people have witnessed that I have chosen to pledge the gift of life: Witness_____________________________ Witness_____________________________ ---------------------------------------------------------------- Print, detach and return this bottom portion to The Masonic Temple One North Broad Street Philadelphia, PA. 19107-2598. |