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DONOR REGISTRATION FORM
Give the Gift of Sight. Become an Eye Donor.
Full name
Email Address
Mobile Number
Select gender
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Address
Select District
Alappuzha
Ernakulam
Idukki
Kannur
Kasaragod
Kollam
Kottayam
Kozhikode
Malappuram
Palakkad
Pathanamthitta
Thiruvananthapuram
Thrissur
Wayanad
Select State
--Select State--
Kerala
I hereby give my consent to donate my eyes after my death for the purpose of Transplantation or Medical education or Research
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