Welcome to Team Illinois
This is the form you complete to register as a team member for Team Illinois only. You will register separately for the Donate Life Transplant Games of America once you enter the "Members Only" section of this website.
Membership Status
This describes your connection to the Transplant Games.
Choose one. *
Contact information
This is the main database for any information on you. Please be as thorough as possible. Thank you!
Name (first, last, nickname) *
Street Address *
City *
State *
Zip Code *
(five-digit postal code)
Email *
Landline Telephone Number (with area code) *
Cell Phone Number (with area code) *
Choose one: *
This describes your membership in Team Illinois.
Required
Guardian name
(if applicant under 17)
Would you be interested in helping on a committee?
Clear selection
If yes, please indicate your area(s) of interest and/or expertise.
Clear selection
Do we have your permission to use your individual photo for publicity purposes?
[Team photos and TGA competition photos automatically imply permission.]
Clear selection
Transplantation information
We would like these demographics for our records. Please share if willing.
Date of Birth (xx/xx/xxxx)
Type of transplant received
Date of transplant (xx/xx/xxxx)
Name of transplant center
[Name and location of the hospital where you had your transplant]
Type of transplant
Please share your story. In doing so, you give us permission to use this information.
Uniform Ordering
This information will be used to order the appropriate uniform for the Games.
Gender *
Choose one.
General size category. *
Mark only one oval.
Shirt size *
Choose one.
Required
Shipping address if different from above
Submit
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