AGH Donor Wall

Your Name(Required)

First Last

Your Email(Required)

Your Phone Number(Required)

Would you like your loved one included on the Allegheny General Hospital Donor Wall?(Required)

Yes

Donor's Name(Required)

First Last

Hometown City/State

City State / Province / Region

Donor's Date Of Birth

Date of Donation

How will you submit your loved one's photo?

I will upload a digital photo below.

I will send a physical copy in the mail. (Please note: physical copies will not be returned to you.)

Please upload a photo of your loved one to be included on the Allegheny General Hospital Donor Wall

Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 64 MB.

Message to Accompany the Photo (max. 120 characters)

By submitting my loved one's photo, I give CORE and AGH to permission to use their likeness as a part of the donor memorial wall.(Required)

I understand.

I do not wish to participate.

If you did not upload a photo, please mail the physical copy of your photo to:

CORE
Attn: Kara McElree
204 Sigma Drive
Pittsburgh, PA 15238

Name

This field is for validation purposes and should be left unchanged.