12605 East 16th Avenue, MS F768, Room 3026-2026

1. Click ‘Get Form’ to open it in the editor.
2. Enter today’s date in the designated field at the top of the form.
3. If your event will take place in an MPL, check the corresponding box.
4. Fill in the date and time you will pick up the organs, ensuring it falls within the specified hours.
5. Provide detailed information about the materials requested, including specifics on organs needed and any relevant disease processes.
6. Acknowledge your responsibility for the gross organs by selecting 'YES' or 'NO' for each liability statement provided.
7. Complete all fields regarding the location of your event, start and end dates, and return details for the organs.
8. Fill in your contact information including phone number and email address.
9. Sign and print your name along with your job title before submitting the form.

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