Join Team Georgia TGA

TeamGeorgiaTransplant
Email: info.teamga@gmail.com

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Team Georgia TGA - Member Information Application

Member classifications are solid organ transplant recipients (heart, lung, liver, kidney, heart, pancreas, intestines, or multiple organs), tissues, cornea recipients, bone marrow recipients, living donors (kidney or liver), donor families, health care professional, or supporters.

First name

Last name

Phone

Birthday

Month

Day

Year

Address

Multi-line address

Country/Region

Address

City

Zip / Postal code

Dropdown

Transplant or Donation Date

Month

Day

Year

Gender

Age

Spouse Name

Marital Status

Children's Names if may be involved with team.

Employer

Occupation

Type of Transplant

Transplant Center

Have you contacted or met your donor's family?

Yes

Living Donor, type of donation:

To Whom did you donate?

If Donor Family, Relationship to Donor?

How many lives did your donor save and/or enhance?

Donor Family, have you met or contacted your loved one's recipients?

Yes

Share your story connecting you to Transplant/Donation.

Emergency Contact Information: Name/Cell Phone/Relationship

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