ANATOMICAL GIFT

                       UNIFORM DONOR CARD

     I, the undersigned, hereby make this anatomical gift, if
medically acceptable, to take effect upon my death.  The words
and marks below indicate my desires: 

     I give: 
           _
     a.   |_|  Any needed organs and/or parts for any 
          purpose. 
           _
     b.   |_|  Only the following listed organs and/or
          parts for the purpose of transplantation, therapy,
          medical research, or education                         
                                                                .
           _  
     c.   |_|  My body for anatomical study if needed.   

     The following are limitations and/or special wishes with
regard to this anatomical gift:                                  
                                                                 
                                                                .



     Signed by the donor and the following witnesses in the 
presence of each other: 


_________________________     Birth Date of Donor:______________
Signature of Donor

Date Signed:_____________     Address of Donor:_________________

                              __________________________________


_________________________     __________________________________
Witness                         Address

_________________________     __________________________________
Witness                         Address