17. Check the box below if you want to
participate in the organ donate program
18. Check the box below if you want to
participate in the organ donate program
19. Check thebox below if you want to
participate in the organ donate program
Check the box below if you don't want to
participate in the organ donate program
20. Check the box below if you want to
participate in the organ donate program
Check the box below if you don't want to
participate in the organ donate program