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Leave a Legacy of Sight
Have you ever thought about being an
eye donor? Every year, thousands of people, from babies to senior
adults, lose their eyesight. In many cases, it can be restored with a
corneal transplant. When you pledge your eyes, you give someone the hope
of being able to see.
With more than a 90%
success rate, corneal transplants are the most successful form of
transplant surgery. All eye tissue is used regardless of the age of the
donor, either through surgery or research. There is no cost to the donor
family for any of the services. To become an eye donor, just print out
this form and keep it with you, or you can sign the back of your NY
driver's license. If you have questions, please contact us at one of the
numbers below the form.
EYE DONOR FORM
Lions Eye Bank at Albany
Sight Society of Northeastern New York , Inc.
This is to certify that
_____________________________ has donated his/her eyes at death to the
Sight Society of Northeastern New York, to be used to help restore sight
of an individual suffering from corneal blindness and/or for research
seeking to prevent blindness and find cures for diseases of the eye.
Signature of the donor
____________________________________________
Date of Birth ___________________
Date signed ____________________
Signature of companion/witness
____________________________________
Telephone number __________________
Signature of second witness (pref. next
of kin) ____________________________________
Telephone number __________________
This is a legal document
under the Uniform Anatomical Gift Act or similar laws.
Lions Eye Bank at Albany
6 Executive Park Drive, Albany, NY 12203
Phone: (518) 489-7606; FAX: 518-489-7607
www.lionseyebankalbany.com/
jbeach@lionseyebankalbany.com
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