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The "Give a Little" Project
Organ Donation Survey
Your Name?
*
Your Occupation?
*
Your City?
*
Your Email Address?
Are you an Organ Donor?
*
Yes, thanks to the "Give a Little" project !
Yes, I was already an organ donor
No, but I am thinking about it
No, I am sceptical about all this
If yes, which organ(s) have you pledged to donate?
Corneas
Kidneys
Heart
Lungs
Liver
Pancreas
Any part of my body, after I am no more
Any other comment you wish to share?
Please visit the
"Give a Little"
project website, if you have any questions regarding this survey.
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