CSM BDP Registration Form

CUMMING SCHOOL OF MEDICINE
REGISTRATION FORM - COMPLETE THIS PAGE
It is my wish that upon my death, my body, if acceptable, be donated to the Body Donation Program, Cumming School of Medicine at the University of Calgary to be used for medical education or medical research.

I acknowledge that I am 18 years of age or over. I do not object to the cremation of my remains following the study and I am aware registering does not guarantee my acceptance into the program. (See: FAQ Section of our website for further details)
Name in Full (please print)*
Birth Date: day/month/year*

MonthDayYear
Date
Signature*

Clear
Witness Name in Full (please print)*
Witness Signature (executor or next of kin preferred)*

Clear
Registrant’s Mailing Address*
City*
Province*
Postal Code*
Telephone Number*
Date*

MonthDayYear
Date
Should be Empty:

CUMMING SCHOOL OF MEDICINE