PDF-Page Final Draft Donation Agreement Revis ed DONOR NAME MALEFEMALE FIRST MIDDLE LAST

OF YEARS IN THIS COUNTY DATE OF BIRTHSTATE OF BIRTH OR FOREIGN COUNTRY FULL NAME OF FATHER BIRTHPLACE OF FATHER FIRST MIDDLE LAST FULL MAIDEN NAME OF MOTHER BIRTHPLACE OF MOTHER FIRST MIDDLE LAST SOCIAL SECURITY US ARMED FORCES Yes No Unknown. SA 65118 65128 656001 65 6007 KAR 2812 2814 and 281 18 Changes effective as of 929 20 14 Mail o r fax reports to your local health department andor to KDHE Bureau of Epidemiology and Public Health Informatics 1000 SW Jackson Suite 075 Topeka KS Have you ever worked for Big Lots before Yes No If yes when and where If hired can you supply proof that you are legally entitled to work in the United States for any employer Yes No Do you have friends or relatives working for us Yes No If so who C Signature Date Please List First Name of all Children under 18 in the Home 1 2 3 4 5 6 7 8 Christmas Gift Pick Up Christmas gifts can be picked up beginning December 8 Please plan to pick up gifts at your December food appointment Family brPage Under the Family Education Rights and Privacy Act of 1974 Buckley Amendment which gives students the right to inspect and review their education records students waive their right to see speci64257c con64257dential statements and letters of recommen Therefore the customer s hould not commit to any non cancelable reservations or other arrangements Chevrolet will not compensate anyone for lost time missed arrangements or expenses incurred due to delays in production and delivery date x The custom CoachAthletic Director Signature Date 14438 814 201415 ENTRY DEADLINE POSTMARKED BY MARCH 27 2015 DEXTERUSBC High School AllAmerican Team COACHESATHLETIC DIRECTORS NOMINATION FORM DEXTERUSBC HIGH SCHOOL ALLAMERICAN INFORMATION The United Stat Why?. Blood . safety starts . by . bleeding safe Blood donors “. Safe Blood starts with me. ”. BTS need to I. mplement adequate donor selection criteria to insure Blood supply safety. BTS need also to insure donor safety. Let Life Bloom. Goals. Increase the number of donor designations in the U.S. – 100,000 by May 2015. Spread the organ donation message. Cultivate a hospital culture that incorporates educating and registering donors as part of their standard mission. www.DonateLifeAZ.org. Donor Network of Arizona. Federally designated, nonprofit, . organ procurement organization (OPO). OPOs - . Responsible for two main functions within their designated service area:. in. . Healthy Living Classrooms. DonateLifeNC.org. Our mission is to inspire more North Carolinians to register as organ, eye and tissue donors. DMV – driver’s license. Teen Outreach – Drivers Ed and Healthful Living. Presenters:. Marcia . Penido. , LCSW, Huntington Hospital. Robert Coppel, OneLegacy. Michelle Post, LMFT, OneLegacy. Breakout Session B:. The Donation Process – The Continuum of Care. June 20-21-22 2012 The Clinic will be from 100 pm Wednesday to 500 pm Friday McCurtain County Fairgrounds Idabel Oklahoma The Victory Lamb Goat Clinic is open to all 4-H FFA members The clinic will AND . VOLUNTARY BLOOD DONATION CAMPS. . SOURCE OF BLOOD . . Blood Donor . Value Blood Donor as . VIP. Should meet defined Donor Selection criteria . composed of a panel of on-call intensivists who assist the OPO with donor management. Intensivist goal’s shift from: . O. ptimizing cerebral perfusion pressure. Hemodynamic stability. Diagnosing neurological death.