Information entered into the enrollment form above is submitted to the New York State Donate Life Registry (Registry). Using information provided on the form, the Registry uses third-party identity verification sources to confirm the identity of every person that enrolls through this website. The last four digits of the social security number and answers to the multiple-choice questions are used for identity verification purposes only and are not retained. Once the identity is confirmed, the enrollee is brought to a confirmation page where they may update their information and make changes to their donation. If the enrollee’s identity cannot be verified, they are given an opportunity to print and sign a form to submit by mail or email.
By clicking the Submit button, I affirm under penalty of law that I am the individual on the above form, I consent to the submission of this information to verify my identity and enroll in the Registry, and I accept the Terms and Conditions of this website. I understand that I am electronically signing this Registry enrollment form, and this electronic signature is the legal equivalent of my handwritten signature. I also understand that if my above registration information cannot be verified, I will be unable to join the Registry through this document.