Donate Life Maryland

Join the Maryland Donor Registry! Donate Life Maryland's online registration is a fast, easy and secure way to designate yourself as an organ, eye and tissue donor.

Required fields denoted with an asterisk (*)

Drivers License/ID #:

Why do we ask for this? Providing your Driver's License or State ID Number provides Donate Life Maryland with a unique piece of information that can be used to identify you and make sure your wishes are honored.

First Name *:

Middle Name:

Last Name *:

Date of Birth *:

Gender *:

FemaleMaleX

Address (Line 1) *:

Address (Line 2):

City *:

State *:

Maryland Not a Maryland Resident?

Zip *:

Email *:

Username/Password

Please create a username and password to allow you to access your record and make any future modifications to your registry entry.

Passwords must contain at least:

seven (7) characters
one (1) uppercase character (A-Z)
one (1) lowercase character (a-z)
one (1) numeric character (0-9)
one (1) special character

Username:

Password:

Confirm Password:

Yes, I accept the Terms and Conditions *

Register Now

Username/Password