Secretary of State Jesse White

Secretary of State Organ & Tissue Donor Program
MATERIALS REQUEST FORM

A message from Secretary of State Jesse White

As Illinois Secretary of State, I have made it a priority to educate the genaral public about the benefits of organ and tissue donation. While our state continues to be the leader in registering potential donors, there are still many more people on the waiting lists than there are available donors.

For this reason, the Secretary of State's office has developed a comprehensive list of materials to assist you in your efforts to help raise awareness for donation. ALL MATERIALS ARE FREE. Please feel free to duplicate this form as needed.

Jesse White
Secretary of State

Please note: This form is for Illinois residents only. If you feel you have a legitimate out-of-state request please call 1-800-210-2106.

Name

 

School
 

 

Street Address

Phone Number
 

City

State
Zip Code
 

E-mail Address
 

 
Type the number of requested items in the box to the left of each item. Click the submit button after your selections have been made.

"It's Up To You" Brochures:
These brochures list general facts regarding organ and tissue donation with a perforated section for people to join the First-Person Consent Registry.

Walter Payton License Plate Application:
These application forms are for organ/tissue donor license plates, honoring Walter Payton. They also list other vehicle plate fees.

"Life Goes On" Pens:
These pens have the organ/tissue donor logo, "Life Goes On".

Posters:
Posters are 17"x22", designed by the overall poster contest winner in the Secretary of State's Bi-Annual Organ/Tissue Donor Poster Contest statewide. Entries are from students from grades K-12. The winner has his/her poster distributed to all driver service facilities, libraries, and hospitals across the state.

Magnets:
Magnets are 2 "x 3" with the "Life Goes On" logo.

"It's Up To You" Window Decals:
4"x6" window decals are removable with our website, www.LifeGoesOn.com and the donor message, "It's Up To You".

"It's Up To You" Floor Decals:
4'x6' floor decals are removable with our website, www.LifeGoesOn.com and the donor message, "It's Up To You". They are great for use in classrooms, supermarkets, businesses, etc.

If you have any questions please call our hotline: (800) 210-2106

Or to contact via mail:

IL Secretary of State
Organ/Tissue Donor Program
501 S. 2nd St. Rm. 451
Springfield, IL 62756-9000.