Registration instructions for the Anatomical Gift Program

You may now download the Registration Form, the Vital Statistics Form and the Disclaimer to make a gift of your remains to the Anatomical Gift Program at the Boonshoft School of Medicine. You may fill out each form on your computer or print it first and complete it in writing. In either case, you will need to print and sign each form and return it to us in person or by mail to complete your registration. It is NOT possible to return completed forms to us by fax, on line or by e-mail because of legally required signatures on each form.

1. Download and fill out the forms. You may need Adobe Reader, a free download, to do this.
• Anatomical Gift Program Registration Form
• Vital Statistics Form
• Disclaimer
2. Complete Parts A and B of the Registration Form.
• It is not necessary to have this form notarized; however, you MUST have two people sigh as witnesses to your signature in Part A. The witnesses must be at least 18 years of age and may be friends, acquaintances or family members.
• Return the original copy to us at:
      Anatomical Gift Program
      Boonshoft School of Medicine
      108 White Hall
      3640 Colonel Glenn Hwy.
      Dayton, OH 45435
• Retain a copy for your records. Note that you will not be able to save a completed form on your computer; you will need to print the form.
• Give a copy to a relative, clergy, friend and/or attorney and confirm that said person knows your wishes and the procedure to follow in the event of your death.
3. Complete the Vital Statistics Form.
• Return this form to us with the Anatomical Gift Form.
• Please be as complete and accurate as possible since this information will be used to complete your death certificate. Pay particular attention to the accuracy of dates and your social security number.
4. Complete the Disclaimer form and return it to us.

Once all the forms have been completed and returned to us, you have fulfilled all the legal requirements to become donor. A wallet card will be issued to you. This will contain your name, donor number and a 24-hour phone number to be called in the event of your death.

Please remember to inform us of any future changes in your residence, phone number or marital status, especially if your spouse precedes you in death. This will assist us in keeping our records current and enable us to better communicate with your survivors.