Contest Registration Form

Name:
Address:

City:
State:
Zip Code:

Phone number:

Email address:
Confirm Email address:

Group Name:
	"By submitting my address, I hereby agree to all the terms and conditions indicated. I: (i) have read, understand, and will comply with the Contest Rules attached and posted on NYDonatesLife.org Contest Information page; (ii) release and discharge the Released Parties and their respective parents, subsidiaries, affiliates, etc. from and against any liability arising from the Contest; and (iii) consent to the announcement and use by Released Parties of my name, likeness, voice, photograph and/or statements for advertising and promotional purposes in any mediums including, but not limited to, Internet, broadcast, cable, print, point of sale, and outdoor; and (iv) will execute a written acknowledgement of these Rules if I am selected as a winner of the Contest. Finally, I acknowledge that by submitting my address I am enrolling with New York State’s organ and tissue donation registry."
	I agree to the "Saving Lives" Contest Rules

This grant-funded project promotes organ donation among young adults in New York State. The project is supported by Grant # D71HS09611 from the Health Resources and Services Administration (HRSA), Healthcare Systems Bureau, Division of Transplantation. Its contents are solely the responsibility of New York Alliance for Donation, Inc. and do not necessarily represent the official views of the HRSA.

Questions about this project can be addressed to Melanie Evans or Michael Stefanone.