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How to Request a Registration Packet

HIPAA Policy

Our HIPAA privacy policy 

The National Institute of Child Health
and Human Development which funds
the Brain and Tissue Bank has
established guidelines that we must
follow to determine if individuals are
eligible to become registered
donors to the Brain and Tissue Bank.
 

We welcome applications for registration from all interested individuals who reside in the USA or Canada.

IF DEATH OR SURGERY IS IMMINENT, PLEASE CALL 1-800-847-1539 INSTEAD OF FILLING OUT THE ONLINE APPLICATION. 

STEP 1

COMPLETE THE DONOR REGISTRATION FORM to notify the Bank at the University of Maryland of your intention to donate and to register name, address, and other vital information. Several methods of registering are available to you.

  • Register ON-LINE! It's secure, easy, and fast. Use our secure server to complete and submit our on-line Donor Registration Form. (Please use Microsoft Internet Explorer.)
  • You may download our registration form which you can then print out, complete, and mail or fax to us.
  • You may call us at 1-800-847-1539 or 1-410-706-1755 and we will provide you with a registration form (via mail or fax) which you can complete and mail or fax to us.

STEP 2

Contact Us

If you have any questions, please call us at 1-800-847-1539 or 1-410-706-1755 to discuss any and all concerns relating to donation. Your call will be received in the strictest of confidence.

INFORM FAMILY MEMBERS AND PHYSICIAN of your decision to donate. This is extremely important since the next of kin must give final permission for tissue recovery, even if a donor has registered in advance.

STEP 3

COMPLETE ANATOMICAL GIFT ACT FORMS AND ACCESS TO MEDICAL RECORDS FORMS. You will receive these forms by mail together with additional materials after we receive your registration form. Please complete these forms and return them by mail to the Brain and Tissue Bank. We need to have the original of these forms with your signature. YOUR REGISTRATION IS NOT COMPLETE UNTIL WE RECEIVE THE SIGNED CONSENT FORMS.  

ALL DONOR INFORMATION REMAINS ANONYMOUS, AND ANYONE WHO REGISTERS
HOLDS THE RIGHT TO WITHDRAW AT ANY TIME.