Memorial Sign Order Form

Purchase

Donation Amount:

$ 30.00

Upload Photo for Sign

Please include what you would like written on the sign. See the pictures below for examples.

It must be brief and something along the lines of:

Mary. Mom, Friend, Scuba diver. Donor Hero, Saved 3 Lives. OR
Bob. Husband, grandfather, avid golfer, Grateful Liver Transplant Recipient.

Writing for Sign

By submitting this memorial sign request, you hereby consent to the use of my/our name(s) and likeness(es) for the sole purpose of promoting organ, tissue, and eye donation. You understand that the use of your name(s) and likeness(es) may include, but not be limited to photographs, newspaper articles, brochures, displays, television, radio, internet or any other public community relations material. You hereby acknowledge that this authorization is volunteered without obligation of any kind on the part of DonorConnect, its employees, and designated agents. This authorization is given without hope or expectation of reward or compensation of any kind. You hereby waive your right to inspect or approve any materials which may from time to time be created by DonorConnect and which may include your name(s), image(s), photo(s), likeness(es) and voice(s).

Select Payment Method

Offline Donation
Stripe - Credit Card

Personal Info

First Name *

Last Name *

Email Address *

Credit Card Info

This is a secure SSL encrypted payment.

Card Number *

CVC *

Cardholder Name *

Expiration *

Here's what you're about to donate:

Donation Summary
Payment Amount
Giving Frequency	One time
Donation Total

Donation Total: $30.00

Buy Memorial Sign

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