Ramayamma International Eye Bank

In the hope that may help others I hereby make this gift, if medically acceptable, to take effect upon my death. The submission in the form indicates my desires.

I give my eyes for the purpose of transplantation, medical research or education.

I further direct my next of kin, herein named, to execute this gift after my death.

I would like my next of kin notified of my pledge to donate my eyes.*
   
   
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