Giving Life a Second Chance
Through Organ & Tissue Donation

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Request a Speaker

Please fill out the form below to request a speaker to discuss organ and tissue donation.

*Please not that the Gift of Life Donor Program service region covers counties in eastern Pennsylvania, southern New Jersey, and Delaware. For speakers in other regions of the country, please contact your local organ procurement organization.

Thanks for your support!

* Required Fields
First Name*
Last Name*
Email Address*
Retype Email Address*
Organization Name*
Street Address*
Zip Code*
Describe the event for which you'd like a speaker?*
Date Event is Taking Place (DD/MM/YYYY)
Time of Event
Daytime Phone Number*
What is your preferred method of contact from Gift of Life Donor Program?*

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It’s easy to add the donor designation to your driver's license or state I.D. card. In Pennsylvania, New Jersey and Delaware. Sign up today!

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