Donate Life Month 2023 Participation

Please complete the form below to submit an organization for recognition of their participation in Donate Life Month 2023.

Deadline: May 5

Donate Life Month 2023 Recognition

First and Last Name(Required)

Email(Required)

Hospital/Organization Name(Required)

ADOT MVD or ATP only – Office Name/City

Did you set a registration goal for new registrants to the DonateLifeAZ Registry? (via QR code, registration cards, etc.)(Required)

Yes

N/A ADOT MVD office

If yes, what was your goal of new registrants to the DonateLifeAZ Registry?

How did this organization participate in Donate Life Month 2023? Please check all that apply.(Required)

Other ways this organization participated that were not listed above

What made your organization's participation unique? Please provide any details about the items you checked above.(Required)

Photos

Drop files here or

Max. file size: 300 MB.

Please upload any photos/screenshots to show this organization’s participation.

More Photos

Drop files here or

Max. file size: 300 MB.

Please upload any photos/screenshots to show this organization’s participation.

Untitled

First Choice

Second Choice

Third Choice